The cognitive approach to treating depression Flashcards
Client preference
On one hand the main consideration is that people get better after treatment. CBT for depression focuses on identifying and changing unhelpful patterns of thinking and behaviour, and there is a large body of evidence to show that, when used appropriately this is highly effective. At least in the short term, most people with depression get better after tackling symptoms with CBT.
On the other hand, we should consider people’s wishes, and not all clients want to tackle their depression using CBT. Some people just want their symptoms gone as quickly and easily as possible and prefer medication. Others, for example survivors of trauma, wish to explore the origins of their symptoms. In fact there is some evidence that CBT is people’s least favourite treatment for depression. In a study of client preference, Antoine Yrondi et al. (2015) found that depressed people rated CBT as their least preferred psychological therapy. This raises the ethical issue of client choice.
This suggests that people, even those who are depressed, should have the right to choose their therapy even if it may not be the one with the best evidence.
Evidence for effectiveness
One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.
Many studies show that CBT works. For example, John 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, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. So CBT was just as effective when used on its own and more so when used alongside antidepressants. CBT is usually a fairly brief therapy requiring six to 12 sessions so it is also cost-effective.
This means that CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service.
Suitability for diverse clients
One limitation of CBT for depression is 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 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.
Counterpoint
Although the conventional wisdom has been that CBT is unsuitable for very depressed people and for clients with learning disabilittes, there is now some more recent evidence that challenges this. A review by Gemma Lewis and Glyn Lewis (2016) concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression. Another review by John Taylor et al. (2008) concluded that, when used appropriately, CBT is effective for people with learning disabilities.
This means that CBT may be suitable for a wider range of people than was once thought.
Relapse rates
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.
