Don’t need - The Cognitive Approach To Treating Depression

Question 1

What is cognitive behavioural therapy?

Answer 1

A combination of cognitive therapy (a way of changing maladaptive thought and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs.

Question 2

Who created CBT?

Answer 2

Ellis - 1950s

Question 3

What did Ellis call his therapy?

Answer 3

Rational emotional therapy (RET)

Rational emotional behaviour therapy (REBT)

Question 4

How did Ellis extend his ABC model?

Answer 4

ABCDEF

D - refers to Disrupting irrational thoughts and beliefs
E - the Effects of disrupting and effective attitude to life
F - new Feelings (emotions) are produced.

Question 5

What does REBT focus on?

Answer 5

Challenging or disputing the irrational thoughts/beliefs and replacing them with effective, rational beliefs.

Question 6

What are the types of disputes?

Answer 6

Logical disputes
Empirical disputes
Pragmatic disputes

Question 7

What is logical disputing?

Answer 7

Self-defeating beliefs do not follow logically from the information available.

E.g. does thinking in this way make sense?

Question 8

What is empirical disputing?

Answer 8

Self-defeating beliefs may not be consistent with reality

E.g. where is the proof that this beliefs is accurate?

Question 9

What is pragmatic disputing?

Answer 9

Emphasises the lack of usefulness of self-defeating beliefs

E.g. how is this belief likely to help me?

Question 10

What does effective disputing change?

Answer 10

It changes self-defeating beliefs into more rational beliefs.

The client can move from catastrophising (no one will ever like me) to more rational interpretations of events (my friend was probably thinking about something else and didn’t even see this).

This in turn helps the client to feel better, and eventually become more self-accepting.

Question 11

How is homework involved in CBT?

Answer 11

Clients are often asked to complete assignments between therapy sessions.
This might include asking a person out on a date when they had been afraid to do so before for fear of rejection, looking for a new job, asking friends to tell them what they really think about the person…

Question 12

Why is homework vital?

Answer 12

In testing irrational beliefs against reality and putting new rational beliefs into practice.

Question 13

What is behavioural activation?

Answer 13

CBT often involves a specific focus on encouraging depressed clients to become more active and engaged in pleasurable activities.

Question 14

What is unconditional positive regard?

Answer 14

The therapist provides respect and appreciation regardless of what the client does and says

Question 16

Why is unconditional positive regard important?

Answer 16

Ellis (1984) came to recognise that an important ingredient in successful therapy was convincing the client of their value as a human being.

Question 17

How does unconditional positive regard work?

Answer 17

If the client feels worthless, they will be less willing to consider changing the beliefs and behaviour.

However, if the therapist provides respect and appreciation regardless of what the client does and says (i.e. unconditional positive regard), this will facilitate a change in beliefs and attitudes.

Question 18

What are the evaluative points?

Answer 18

Research support 
Individual differences 
Support for behavioural activation 
Alternative treatments 
The Dodo bird effect

Question 19

What is meant by research support?

Answer 19

Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment.

However, he recognised that the therapy was not always effective, and suggested that this could be because some clients did not put their revised beliefs into action (Ellis, 2001).

REBT, and CBT in general, have done well in outcome studies of depression (i.e. studies designed to measure the outcome of treatment).
For example, a review by Cuijpers (2013) of 75 studies found that CBT was superior to no treatment.

Therapist competence appears to explain a significant amount of the variation in CBT outcomes.
Kuyken and Tsivrikos (2009) lend support to this claim, concluding that as much as 15% of the variance in outcome may be attributable to therapist competence.

Question 20

What is meant by individual differences?

Answer 20

CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change (Elkin, 1985).

CBT also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person’s life that therapy cannot resolve (Simons, 1995).

Ellis also explained a possible lack of success in terms of suitability - some people simply do not want the direct sort of advice that CBT practitioners tend to dispense.
They prefer to share their worries with a therapist without getting involved in the cognitive effort that is associated with recovery (Ellis, 2001)

Question 21

What is meant by support for behavioural activation?

Answer 21

The belief that changing behaviour can go some way to alleviating depression is supported by a study on the beneficial effects of exercise.

Babyak (2000) studied 156 adult volunteers diagnosed with major depressive disorder.
They were randomly assigned to a four-month course of aerobic exercise, drug treatment (an antidepressant drug) or a combination of the two.
Clients in all 3 groups exhibited significant improvement at the end of the four months.

Six months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group, particularly among those who had continued with an exercise regime on their own.

Question 22

What is meant by alternative treatments?

Answer 22

The most popular treatments for depression is the use of antidepressants such as SSRIs.

Drug therapies have the advantage of requiring less effort on the part of the client.
They can also be used in conjunction with a psychotherapy such as CBT. This may be useful because a distressed client may be unable to focus on the demands of CBT but the drug treatment enables them to cope better.

The review by Cuijpers found that CBT was especially effective if it was used in conjunction with drug therapy.

Question 23

What is meant by the Dodo bird effect?

Answer 23

Saul Rosenzweig (1936) argued that all methods of treatment for mental disorder were pretty much equally effective, an observation he called the Dodo bird effect after the Dodo bird in Lewis Carroll’s Alice in Wonderland who decided that everyone should win.

Research does tend to find fairly small differences in success rates, for example Luborsky (1975, 2002) reviewed over 100 different studies that compared different therapies and found that there were only small differences

Rosenzweig argued that the lack of difference was because there were so many common factors in the various different psychotherapies.

The commonalities include being able to talk to a sympathetic person, which may enhance self-esteem, and having opportunity to express one’s thoughts (Sloane, 1975).