Psypath: CBT/cog. approach to treating depression AO1 + 3 Flashcards
What is the cognitive element of CBT?
Identify irrational/negative thoughts, replace them w/positive ones
What is the behaviour element of CBT?
Encourages pts to test beliefs through behavioral experiments + homework
What is the central premise of CBT?
Thoughts/feelings/behaviour impact each other- if an irrational thought can be identified it can change other ppl’s emotions + behaviour
How CBT is administered?
Initial assessment- CBT therapist works w/pt to identify problems
Goal setting- pt + therapist agree on set of goals + plan of action to achieve them
Identify automatic negative/irrational thoughts in relation to themselves/their world/their future (Beck’s negative triad) or Ellis’ ABCs model
What is meant by patient as scientist?
Generalising + testing hypotheses abt validity of irrational thoughts; realise thoughts don’t match reality, schemas change- irrational thoughts= discarded
What is cognitive restructuring?
Perspectives reframed- change in feelings/behaviours
What is thought catching?
Identifying irrational thoughts coming from negative triad of schemas
What is behavioural activation?
Engage in more active + enjoyable activities (e.g. sports/socializing/travelling).
Important to combat depressive symptoms of isolation and loss of interest.
What is Ellis’ ABCDE model?
Dispute- therapist asks client to dispute/challenge irrational thoughts + beliefs as utopianism- involves vigorous argument (hallmark of REBT- Rational Emotive Behaviour Therapy)
Effective new responses- therapist asks client to think of more rational responses
What are the types of disputing?
Empirical- assessing if there is evidence for the thought
Logical- assessing whether the thoughts follow from the facts.
Pragmatic- assessing if thought is helpful
strength CBT- large body of evidence to support its effectiveness- esp w/ antidepressant treatment.
E- March et al (2007)- 327 adolescents w/a depression diagnosis + looked at effectiveness of CBT, antidepressants, and a combo- 36 wks, 81% of antidepressant group + 81% of CBT group improved. 86% of combo group improved.
E- shows CBT is effective- 81% of pts symptoms improved, but research suggests that a combo of both is effective.
L- therefore, cognitive treatment of depression is effective, but not comprehensive + physiology also needs to be considered, which can be addressed w/ drug therapy
limitation CBT- unsuitable for all patients, e.g. those with learning disabilities
E- Sturney (2005) pts w/learning disabilities can’t access complex rational thinking of ‘talking therapy’. Also, pts whose depression is so severe can’t motivate themselves to engage w/cognitive work of CBT.
E- suggests CBT no appropriate for all pts w/depression.
E- however, recent ev. conflicts w/this- Lewis & Lewis (2016) efficacy of CBT for severe depression = antidepressants, Taylor et al (2008) found CBT w/appropriate adjustments used w/pts w/learning difficulties.
L- CBT may be more broadly applicable than prev. considered, but application may need modification
limitation CBT- high relapse rates
E- Ali et al (2017) assessed depression in 439 clients for 123 months after a course of CBT. 42% of pts relapsed within 6 months, 53% in 1 yr.
E-suggests few earlier studies had looked at l-t effect- not be as high as assumed. 1 reason=CBT needs motivation- pts w/severe depression may not engage w/CBT/attend sessions. Drug therapy doesn’t need motivation, more effective
L- ev. supports concern that CBT lacks prolonged efficacy, may limit application to pts of moderate severity, whereby motivation can be maintained for longer
limitation CBT- efficacy may not depend on the specific techniques of Beck or Ellis, but on patient and therapist relationship
E- Resenzweig et al. (1936) relationship is v. important in determining success of psychological therapy.
E- having someone to talk to might be crucial component in pos. result not specific techniques used. Supported by Luborsky et al. (2002) little diff. w/diff. methods of psychotherapy, suggesting underlying principles don’t differentiate their efficacy.
L- supports concern that efficacy of CBT may be non-specific + unrelated to its cognitive principles, but relies on opportunity for pts to build a trusted relationship which they can confide their concerns
March et al. (2007)
327 adolescents w/a depression diagnosis + looked at effectiveness of CBT, antidepressants, and a combo- 81%, 81%, 86%
Sturney (2005)
Proposed that pts w/learning disabilities can’t access complex rational thinking of ‘talking therapy’
Lewis & Lewis (2016)
Found efficacy of CBT for severe depression was equal to antidepressants
Taylor et al. (2008)
Found CBT w/appropriate adjustments used w/pts w/learning difficulties
Ali et al. (2017)
Assessed depression in 439 clients every month for 123 months after a course of CBT. 42% relapsed within 6 months, 53% in 1 yr
Rosenweig et al. (1936)
Argued the relationship is v. important in determining success of psychological therapy.
Luborksy et al. (2002)
Showed little diff. w/diff. methods of psychotherapy, suggesting underlying principles don’t differentiate their efficacy
CBT
Most commonly used NHS treatment, based on Beck’s Negative Triad, involves cognitive and behavioral elements.
CBT homework
Challenges negative thoughts against reality, puts new rational beliefs into practice (e.g. thought diaries).
Patient as scientist
Generating/testing hypotheses about validity of irrational thoughts- mismatched changes schemas.
cog. restructuring
perspectives= reframed, change in feelings/behaviours
REBT
Ellis’ ABCDE model of expl. (adverse event/behaviour/conseq/dispute/effective new responses)
empirical disputing
evidence for thought
logical disputing
thought follows facts
pragmatic disputing
if thought is helpful
