Lesson 10: Cognitive Treatments For Depression

Question 1

Cognitive approach to treating depression

Answer 1

• cognitive treatments of depression are based on the assumption that faulty thinking makes a person vulnerable to depression.
• CBT involves both cognitive and behavioural elements, cognitive elements is to identify irrational thoughts and replace these earth rational and positive ones, the behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework
• CBT used to treat depression and other mental health problems. CBT begins with an assessment where the patient and therapist work together to clarify the patient’s problems. They jointly identify goals and create a plan for achieving them.

Question 2

What are the components to CBT?

Answer 2

1) Initial assessment
2) Goal setting
3) Identify the negative/irrational thoughts through Beck’s cognitive therapy or Ellis’ REBT
4) Homework

Question 3

Beck’s Cognitive Behaviour Therapy (steps)

Answer 3

• aims to challenge negative thoughts and replace them with more realistic ways of thinking
• behavioural element of the CBT involves working to change negative and irrational thoughts and put more effective behaviours into place
• first the therapist helps the client identify negative thoughts about the world, self and the future, often client is encouraged to keep a record of their thoughts in a diary
• using this material the therapist challenges the negative thoughts by drawing attention to positive incidents - a form of reality testing
• challenging negative thoughts is the central component of the therapy because this is the initial phase of eradicating the negative triad
• along with challenging negative thoughts the therapist uses techniques to encourage more positive thinking and behaviour may provide sessions or homework for training the patient in social skills
• purpose of homework is for the client to act as a scientist e.g. record when they enjoyed an event or when someone’s was nice to them - in this way the client is investigating their negative beliefs as a scientist would

Question 4

Ellis’ Rational Emotive Behaviour Therapy (REBT)

Answer 4

• In Ellis’ ABC model a specific event activates irrational thoughts and these in turn leads to negative emotions and damaging behaviour, these irrational thoughts need to be challenged and rationalised
• REBT extends the ABC model to an ABCDE model (D - dispute) (E-effect)
• REBT seeks to identify and dispute irrational thoughts
• therapist and client work together to identify trigger situations and the negative reactions they produce
• therapist then helps the client to rationalise the situation, giving the client a more realistic perspective
• ellis believes in a more confrontational approach to therapy where the client was challenged on their self-defeating beliefs in intense debates. This may be through logical disputing or asking the client to give evidence for a certain negative belief
• following a session, the therapist may set their patient homework. Idea is that the patient identifies their own irrational beliefs and then proves them wrong. As a result, their beliefs began to change.

Question 5

Strengths of CBT

Answer 5

+ Research support - March et al (2007) compared the effects of CBT with anti-depressants and a combination of the two in 327 depressed adolescents. After 36 weeks, both 81% of the anti-depressants and CBT groups improved. However, 86% of the CBT plus anti-depressants group improved suggesting that the treatment is as effective as medication and also helpful alongside medication.

+ There is evidence that the benefits of CBT last longer than those of anti depressant drugs and unlike drugs there are no side-effects or withdrawal symptoms. For example, the fact that CBT also requires the individual to change their behaviour as well as their thoughts shows how change is occurring in the long term. In a study by Babyak et al (2000) they studied 156 adult volunteers diagnosed with major depression and randomly assigned them to either a four month course of aerobic exercise, anti depressants or a combination of both. It was found that six months after the end of the study, those in the exercise group had significantly lower relapse rates than those on the medication group suggesting that exercise is more effective than medication.

Question 6

Weaknesses of CBT

Answer 6

• CBT may not work for severe cases because they are unable to concentrate or motivate themselves to participate in the sessions, when this happens drug therapy might be more suitable
• Sucess may be due to the quality of therapist-client relationship rather than any particular technique that is used for example some therapies may have excellent social skills thus consequently, the patient may be reinforced to be more dedicated to the treatment
• CBT focuses on the client’s thoughts about a situation and not the situation itself e.g. bullying partners. As a result these environments continue to encourage irrational thoughts.
• CBT requires 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. (Drug therapies are better), CBT usually cannot be used as the sole treatment for severely depressed patients who often lack the motivation to attend therapy and speak about their depression.
• CBT is time consuming and expensive compared to drug therapy. CBT requires the client attending therapy sessions which obviously requires money and time and of course effort from the client as they have to face and talk about their depression whereas with drug therapy it is quick and cheap.