Psychopathology: The cognitive approach to treating depression Flashcards
What is CBT?
A combination of cognitive therapy (changing maladaptive thoughts and beliefs) and behavioural therapy (changing behaviour in response to these thoughts and beliefs)
Define irrational thoughts
Patterns of thinking that are illogical, distort reality and prevent you from reaching your goals. They also lead to unhealthy emotions and self-defeating behaviour.
What does CBT involve?
- Challenging irrational thoughts
- Homework
- Behavioural activation
- Unconditional positive regard
CBT: challenging irrational thoughts
Ellis developed his ABC model to include D (dispute) and E (effect or effective). Like Beck, the main idea is to challenge irrational thoughts, however, with Ellis’s theory this is achieved through ‘dispute’ (argument). The therapist will dispute the patient’s irrational beliefs, to replace their irrational beliefs with effective beliefs and attitudes. There are different types of dispute which can be used, including logical dispute – where the therapist questions the logic of a person’s thoughts, for example: ‘does the way you think about that situation make any sense?’ Or empirical dispute – where the therapist seeks evidence for a person’s thoughts, for example: ‘where is the evidence that your beliefs are true?’. Pragmatic dispute emphasises the lack of usefulness of self-defeating beliefs.
CBT: homework
Clients are often asked to complete homework assignments between therapy sessions. Might include looking for a new job, asking someone out on a date when they’ve previously been afraid to do so due to fear of rejection, etc. Vital in testing irrational beliefs against reality, putting new rational beliefs into practice and challenging existing beliefs — attempts to show the client that their beliefs do not correspond to reality.
CBT: behavioural activation
An evidence-based treatment for depression. It is based on the idea that one way to combat low mood is to increase your activity level, especially in: pleasurable activity. tackling lists of tasks and responsibilities in a realistic and achievable way.
CBT: unconditional positive regard
Involves convincing the client of their value as a human being. If the client feels worthless, they will be less willing to consider changing their beliefs and behaviours — so UPR is essential in treating depression. The therapist will provide respect and appreciation regardless of what the client does or says, thus facilitating a change in their beliefs and attitudes.
A03: The cognitive approach of treating depression
+ Research support from Ellis
+ Support for behavioural activation
- Requires motivation
- Individual differences
A03: Research support from Ellis
Research has supported CBT as a useful way of treating depression. Ellis (1957) claimed a 90% success rate, stating that it takes an average of 27 sessions to complete the treatment. He also suggested that if it doesn’t work, it’s because the client did not put their revised beliefs into action rather than because the therapy is ineffective OR it may be the therapist that prevents CBT from working rather than the therapy itself. A review has shown that 75 studies have found that CBT was superior to no treatment.
A03: Support for behavioural activation
The belief that changing behaviour can go some way to alleviating depression is supported by studies on the beneficial effects of exercise. Babyak et al (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 three groups exhibited significant improvement at the end of the four months. Six months after the end of the study, those in the exercise group has significantly lower relapse rates than those in the medication group. This shows that a change of behaviour can indeed be beneficial in treating depression.
A03: Requires Motivation
One issue with CBT is that it 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. Alternate treatments, for example, antidepressants, do not require the same level of motivation and maybe more effective in these cases. This poses a problem for CBT, as CBT cannot be used as the sole treatment for severely depressed patients.
A03: Individual differences
However, CBT may not be a suitable treatment for all depression sufferers. For example, individual differences can affect whether or not CBT is effective from person to person. Some individuals feel very positive about treatments such as CBT and are prepared to engage with the programme whereas others refuse to engage with programme requirements such as the completion of homework tasks/find it difficult to actively apply the principles to their everyday life. This is a weakness as it suggests that CBT would not be the best treatment for all depression sufferers, this means that it is vitally important that the needs of the individual client/patient should always be considered before a course of treatment is decided.
