Psychological treatment of depression (CBT)

Question 1

What is Cognitive behavioural therapy (CBT)

Answer 1

it is the first-line psychological treatment for depression and anxiety disorders, especially for those with mild to moderate symptom severity. it is designed to achieve quick and lasting results with treatment consisting of weekly sessions lasting for about an hour for a period of 3 months - depending on severity.

Question 2

What did Beck propose?

Answer 2

He proposed the cognitive triad.

My mood and emotions influence my thoughts and actions.
^
My thoughts and actions influence the quality of my living .
^
The quality of my life influences my mood and emotions.

Question 3

An example of the triad is

Answer 3

For example, if a person thinks that people don’t like them, they will feel bitter and upset. If they feel this way, they will act defensively and be aloof and cold. If they behave this way, people may not like them.

Question 4

Cognitive Behavioural Therapy (CBT)

Answer 4

CBT involves cognitive and behavioural aspects:

The cognitive aspect aims to identify and change negative and irrational thoughts, which lead to depression. It aims to replace these negative thoughts with positive ones.
The behavioural side of CBT encourages patients to test their beliefs with homework.

• CBT starts with an initial assessment, in which the client and therapist identify the problems and agree on a set of goals. The therapist helps the client identify negative thoughts in relation to themselves, their world and their future.

Question 5

Cognitive Behavioural Therapy (CBT) investigating these irrational thoughts

Answer 5

• The client and therapist work together to investigate these irrational/negative thoughts, discussing evidence for and against them.
• The therapist then tries to challenge automatic negative thinking and offer alternative ways of thinking about problematic situations. This is called cognitive restructuring.
• CBT sets the client homework, which involves putting these negative/irrational thoughts to the test (e.g. asking a friend to come over for coffee to see if they refuse).
• The therapist also gives the client behavioural challenges to carry out between sessions (such as initiating a conversation at work, taking exercise).

Question 6

Effectiveness - STRENGTH

Answer 6

• CBT is clearly structured and has SMART targets, making progress easy to evaluate. Since depression is characterised by cognitive problems, it seems appropriate to treat it with cognitive therapy. There is a lot of research to support CBT.
• Hollon (2002) found that cognitive behavioural therapy (CBT) performs well in controlled trials and is at least as effective as drug treatment in helping with unipolar depression.
• Kuyken et al (2008) found that CBT was more effective in preventing relapse and improving quality of life than antidepressants.
  It is relatively quick and cheap to administer so has government backing.
• The National Institute for Clinical Excellence (NICE) recommends CBT as the first line of treatment for mild to moderate depression. Since NICE and the NHS are government-funded, this represents government backing for CBT in the UK.
• CBT is free on the NHS, but there are waiting lists. If you pay for private therapy, CBT may cost £40-100 per session. That sounds like a lot, but it’s cheaper than psychoanalysis.

Question 7

Ethics - WEAKNESS

Answer 7

• CBT does not carry side effects so is more ethical than drug treatment. However, CBT blames the person for their disorder because it is their thoughts that cause it.
• This could have ethical implications for how the person feels about themselves. On the other hand, CBT aims to give people the tools to enable them to deal with the disorder themselves rather than passively taking drugs.

Question 8

Limitations - WEAKNESS

Answer 8

• Often, self-report data is used to test the effectiveness of CBT. This is not valid as the client may want to please the therapist.

Furthermore, we don’t know how CBT works. There are many techniques involved in CBT and the therapy could be made more effective if we knew which aspects had the most benefit. E.g., critics argue that the benefits of CBT do not come from the role plays and the homework, but from the warm and supportive relationship with the therapist.

-The tendency of participants in any study to show improvement when they think “somebody cares” is known as the Hawthorne Effect. However, the Hawthorne Effect would not explain why clients continue to show improvement even after the therapy ends.

• CBT is accused of being reductionist: it places too much emphasis on cognitions.
• Often, a person with depression has relationships and a social environment that doesn’t just seem bad to them, but which are objectively bad. E.g. they may be living in poverty, experiencing racism or sexual abuse, struggling with drug addiction or excessive workload.
• There may also be biological factors that can’t be changed just by thinking differently.