Cognitive treatments for depression Flashcards
Main aim of CBT
The central aim of Cognitive Behavioural Therapy (CBT) is to change/modify negative/irrational thoughts and so alleviate the depression.
Aim of Beck’s CBT
The aim of this therapy is cognitive restructuring; learning to identify, dispute,
and therefore change, irrational thoughts.
Beck’s CBT
The first step it to identify irrational thoughts/negative triad, this is known as thought-catching. The patient is then encouraged to generate a hypothesis to test the validity of their irrational thoughts, this is known as patient as scientist.
Several strategies are used in CBT to test patient’s hypothesis. The patient may be asked to gather data about behaviour and incidents and then compare the evidence with their hypothesis to check whether they match. The patient may also be asked to complete homework assignments in between therapy sessions to test irrational thoughts out in the real world and then evaluate the evidence. Patients could be asked to keep a diary to record events and identify situations in which negative thinking occurs so these can be targeted.
When patients report positive thoughts they are praised by the therapist, which provides positive reinforcement.
What is REBT
Form of CBT Therapy
Aim of REBT
Ellis (1994) developed a CBT therapy for depression called Rational Emotive Behavioural Therapy (REBT). This therapy aims at challenging automatic negative thoughts and replacing them with rational beliefs
REBT Method
The therapist uses logical arguments to show patients that their self-defeating beliefs do not logically follow from the information available (e.g. just because your friend does not say hello to you does not mean they hate you, it could be that they just didn’t see you).
The therapist also uses empirical arguments to show patients that their selfdefeating beliefs are not consistent with reality (e.g. it does not make sense to believe everyone hates you when they keep inviting you out for dinner).
Patients undertaking REBT are encouraged to engage in behavioural activation; becoming more active and taking part in pleasurable activities. Many depressed patients often do not engage in activities that they used to enjoy.
Advantages of CBT
+ David (2008) found that CBT is a better treatment for depression in the long-term than antidepressants. He compared 170 patients with depression who had 14 weeks of CBT with patients who were treated with the drug fluoxetine. Six months later it was found that patients who had received CBT were less likely to have relapsed.
+ March et al. (2007) found that CBT was as effective as antidepressants in treating depression. The researchers examined 327 adolescents with depression. They looked at the effectiveness of CBT, antidepressants and a combination of the two. After 36 weeks, 81% of the antidepressant group and 81% of the CBT group significantly improved. However, 86% of the combination group had significantly improved. This suggests that a combination of CBT and antidepressants is the most effective treatment
Disadvantages of CBT
- One issue with CBT is that it requires commitment and motivation. Patients with severe depression may not engage with CBT, or even attend the sessions, and therefore this treatment will be ineffective in treating these patients. Alternative treatments, for example, antidepressants, do not require the same level of motivation and may be more effective in these cases. This poses a problem for CBT, as CBT cannot be used as the sole treatment for severely depressed patients.
- CBT relies on patients self-reporting their thoughts as thoughts cannot be objectively observed or measured. These self-reports could be unreliable and it is difficult to verify if they are accurate or not.
- CBT attempts to address the cause of depression as it assumes that the root cause of depression is irrational thought processes. However, psychologists have criticized CBT, as it suggests that a person’s irrational thinking is the primary cause of their depression and therefore ignores other factors or circumstances that might contribute to a person’s depression. For example, a patient who is suffering from domestic violence or abuse does not need to change irrational thoughts, but in fact needs to change their circumstances. Therefore CBT would be ineffective in treating these patients until their circumstances have changed.
Advantages of Beck’s CBT
A strength of CBT is that it is very effective to use when a client has mild depression, as CBT stops the mild depression from getting much worse. Therefore CBT is more applicable to clients who had mild depressive symptoms rather than severe symptoms. If the depression is very severe then drugs/medication might be more appropriate than CBT (+) (-)
Disadvantages of Beck’s CBT
The most popular treatment for depression is anti-depressant drugs. Drugs require less effort than CBT in general. However, Cujipers (2013) found that CBT can be very effective if is combined with drug therapy. Therefore maybe CBT used on its own to treat depression is not very effective, and drugs should be used alongside it. (-)
Advantages of REBT
There is research evidence to support the use of CBT as a therapy for depression. David (2008) compared 170 depressive patients who had 14 weeks of REBT and compared them to depressive patients who were treated with the drug fluoxetine. The outcomes were compared 6 months after the treatment ended, and it was found that REBT was a better long term treatment for depression compared to the drug therapy (+)
Disadvantages of REBT
A disadvantage of REBT is that it is unclear if the distorted negative thinking is the cause of depression or merely a symptom; if it is only a symptom of depression then REBT is not tackling the root cause of the depression, and the depression might return in the future. This means that the depression has not been cured properly (-)
REBT - DEF model
1) Disputing irrational thoughts and behaviour:
a) Logical disputing occurs when self defeating beliefs do not follow logically from the information available, the therapist can ask the depressed client, “Does thinking in this way make sense?”
b) Empirical disputing, whereby self defeating beliefs may not be consistent with reality and there is a lack of evidence e.g. “You believe that everyone hates you, but where is the evidence?”
2) Effects of disputing and effective attitude to life:
Effective disputing can change self defeating beliefs into more rational beliefs. The depressed client can move away from negative and irrational thinking, e.g. “No one likes me” to more rational interpretations of events, e.g. “My friend has not replied to my text message because she is busy, not because she hates me.”
3) Feelings/emotions:
The depressed patient will begin to think in a more positive and rational way and they will begin to feel better. This can have a positive impact on their behaviour.
