PP- Cognitive approach to treating depression

Question 1

What is the aim of Rational Emotive Behavioural Therapy?

Answer 1

REBT is aimed at challenging automatic negative thoughts and replacing them with rational beliefs.

Question 2

What does REBT stand for? Who proposed it?

Answer 2

Rational Emotive Behavioural Therapy

- ELLIS

Question 3

What does the D in the DEF model stand for ? (ELLIS)

Answer 3

DISPUTING IRRATIONAL THOUGHTS AND BELIEFS: The patients irrational thoughts and beliefs are challenged and disputed by the therapist.

Question 4

What are the three ways of disputing irrational thoughts and beliefs?

Answer 4

1) LOGICAL DISPUTING
2) EMPIRICAL DISPUTING
3) PRAGMATIC DISPUTING

Question 5

What is logical disputing?

Answer 5

This is when therapists 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 that they hate you, it could just be that they didn’t see you)

Question 6

What is empirical disputing?

Answer 6

Empirical disputing is when therapists show patients that their self defeating beliefs are not consistent with reality (e.g it does not make sense to believe everyone hate you when they keep inviting you out for dinner, this is not pity, they genuinely want to spend time with you)

Question 7

What is pragmatic disputing?

Answer 7

This is when therapists show patients that their self-defeating beliefs is emphasised (e.g the belief that everyone hates you is not helpful because it means you are not trying to maintain any of your friendships)

Question 8

What does the E in Ellis’s DEF model stand for?

Answer 8

Effects of disputing and effective attitude to life: The new rational thought that occur now that the irrational thoughts and beliefs have been disputed.

Question 9

What does the F in Ellis’s DEF model stand for?

Answer 9

Feelings: The new feelings and emotions that result from the new rational thoughts and beliefs have been disputed.

Question 10

Give advantages of the rational emotive behavioural therapy.

Answer 10

1) A strength of cognitive treatments of depression is that there is support from research for its effectiveness.
- For example, there have been numerous studies that have shown that CBT is effective in reducing symptoms of moderate and severe depression and in preventing relapse, especially for those who only have depression.
- Ellis claimed a 90% success rate of REBT, taking an average of 27 sessions to complete the treatment. David et al. compared the effectiveness of REBT, Beck’s CBT and drug therapy
- This is a strength as all three forms of therapy were comparably effective at the end of treatment. At 6 month follow up, however, there was evidence that REBT was more effective
than the other two forms of therapy.
- Therefore this suggests that as a long term treatment REBT is the most effective and gives us a good case for making CBT a first choice treatment in the NHS.

2) A strength of CBT can be seen in 
how its techniques are 
appropriate for use in a wide 
variety of situations and modes 
of delivery e.g. interactive 
software programmes
- For example, it has been used 
successfully with people of all 
ages with degrees of depression 
from mild to severe.
- This is a strength as it means it is 
not a therapy, which is restricted 
to certain groups of people 
meaning a wide variety of people 
can benefit from it. Moreover, 
CBT does not have the negative 
side effects such as anxiety and 
weight loss often found with 
SSRIs and other drug treatment, 
which makes it suitable to a 
wider variety of people
- Therefore, it is a treatment that 
can be made easily accessible and 
offers help to wide range of 
people with depression

Question 11

Give disadvantages of rational emotive behavioural therapy.

Answer 11

1) Competence of the therapist 
P A problem with the effectiveness 
of CBT is that the competence of 
the therapist has a significant 
impact and leads to variation in 
its outcomes
E For example, Kuyken supports 
this claim, concluding that as 
much as 15% of the variance in 
outcome may be attributed to 
therapist competence. They 
found that the therapists who 
were assessed as most 
competent had better patient 
outcomes regardless of the 
complexity of the case
E This is a problem since the quality 
and of treatment may depend on 
ability of therapists and possibly 
the patient-therapist relationship 
meaning it may not work as well 
for everyone
L Therefore this reduces the 
effectiveness of the treatment

2) May not work everyone 
P A criticism of the appropriateness 
of CBT is that it may not work for 
all personality types or situations
E For example, Simons found that 
CBT was not effective for people 
who have very rigid attitudes and 
who are resistant to change. Such 
people may resist the disputing 
or restructuring suggested by the 
therapists
E It is also not effective for people 
who have high stress levels, due 
to long term problems in their 
lives (such as a disability or an 
abusive marriage); that a brief 
treatment like CBT cannot 
resolve. Considering CBT is 
focussed on a person’s thinking, if 
the cause of CBT is external and 
out of the person’s control (such 
as an abusive relationship) it may 
make the client assume the 
problem is with their own 
thoughts and make them less 
motivated to remove themselves 
from such a hostile environment
L Therefore, this could further 
contribute to their illness, and 
may limit the appropriateness of 
CBT in such situations