psychopathology: cognitive approach to treating depression Flashcards
How do cognitive treatments follow from cognitive explanations?
If faulty thinking explains dysfunctional behaviour then changing faulty thinking is the preferred form of treatment
What are the two main types of cognitive therapy?
- Cognitive behavioural therapy (CBT)
- Rational Emotive Behavioural Therapy (REBT)
What is the predominant therapy used to treat depression?
Cognitive Behavioural Therapy (CBT)
What is Cognitive Behavioural Therapy?
A method for treating mental disorders by attempting to change irrational thinking. The therapist challenges the patient’s thoughts in a constructive way, trying to shift them from a pessimistic to an optimistic interpretation
Who is behind the development of CBT?
Beck - known as Beck’s Cognitive Therapy which is the application of his theory of depression
What are the two elements of CBT?
Cognitive and Behavioural elements
What does the cognitive element of CBT involve?
- CBT begins with an assessment of the patient’s problem between the patient and therapist.
- They jointly identify goals and a plan to achieve them.
- The central task is to identify negative and irrational thoughts that need challenging.
What does the behavioural element of CBT involve?
CBT involves working together to change negative and irrational thoughts and put effective behaviours into place.
Outline the steps of Cognitive Behavioural Therapy?
1) Identify the patient’s problems, negative thoughts etc
2) Help patients to recognise that thoughts lead to emotional states (cognitive primacy)
3) Help patients to challenge negative or distorted thoughts. This may include ‘thought catching’, ‘reality testing’ and ‘homework’ tasks
What is thought catching?
Identifying irrational thoughts coming from the negative triad of schemas and recognising that they lead to emotional states
What might patients be tasked with doing in their ‘homework’?
- To challenge and test their negative thoughts.
- Includes keeping a diary to record negative thoughts and identify situations that cause negative thinking
What is the goal of CBT?
Cognitive restructuring - changing the way you think
What is the goal of Behavioural Activation?
To work with individuals to gradually decrease their
avoidance and isolation and increase engagement in activities known to boost mood.
What is Rational Emotive Behavioural Therapy?
- An extension of Ellis’ ABC model to include D (dispute) and E (effect)
- The main idea is to challenge irrational thoughts, however, with Ellis’s theory this is achieved through ‘dispute’ (argument).
What are the different methods of disputing?
- Logical dispute
- Empirical dispute
What is logical dispute (+ an example) ?
- Where the therapist disputes if the negative thought follows logically from the facts, attempting to show that they don’t make sense
- e.g. ‘does the way you think about that situation make any sense?’
What is empirical dispute (+ an example) ?
- Where the therapists disputes whether there is actual evidence to support the negative belief - e.g. ‘where is the evidence that your beliefs are true?’
What does the effect in the ABCDE model refer to?
- New belief replaces the irrational one
- Breaking the link between the negative thoughts and depression
- Reduction of irrational thoughts (restructured beliefs B) leading to better consequences (C) in the future
What is the difference between Beck’s CBT therapy and Ellis’ REBT?
- In Beck’s CBT therapy, the client is helped to figure out the irrationality of their thoughts themselves by acting as a scientist
- In Ellis’ REBT, the therapist explains the irrationality of the thoughts directly to the patient through disputation
Evaluation: Evidence of its effectiveness -> strength
- Large body of evidence supporting its effectiveness for treating depression.
- Numerous studies and meta analysis show CBT to be effective fora wide range of psychopathology.
- e.g. March et al. (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents.
- After 36 weeks, CBT and drug therapy had an effectiveness rate of 81%
- Best results came from the combination treatment with an effectiveness of 86%
- So CBT was just as effective when used on its own and more so when used alongside antidepressants.
- This means that CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service.
Counterpoint: therapist/patient relationship
- The success of the therapy may be due to the ‘therapeutic alliance’ (therapist/patient relationship)
- It may be one quality of the relationship that determines the success rather than any particular technique used
- So it may not be CBT itself but just having someone to talk to that may be helpful
Evaluation: Suitability for diverse clients -> limitation
- The lack of effectiveness for severe cases and for clients with learning disabilities.
- In some cases depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT.
- They may not even be able to pay attention to what is happening in a session.
- It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities.
- Peter Sturmey (2005) suggests that, in general, any form of psychotherapy (i.e. any ‘talking’ therapy) is not suitable for people with learning disabilities, and this includes CBT.
- This suggests that CBT may only be appropriate for a specific range of people with depression.
Evaluation: Relapse rates -> limitation
- A further limitation of CBT for the treatment of depression is its high relapse rates.
- Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last.
- Relatively few early studies of CBT for depression looked at long-term effectiveness.
- Some more recent studies suggest that long-term outcomes are not as good as had been assumed.
- For example, in one study, Shehzad Ali et al. (2017) assessed depression in 439 clients every month for 12 months following a course of CBT.
- 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.
- This means that CBT may need to be repeated periodically.
