The Cognitive Approach to treating Depression - CBT

Question 1

Cognitive Behavioural Therapy (CBT

Answer 1

Thoughts are perceived as affecting emotions and behaviour.

CBT assists patients to identify irrational/maladaptive thoughts and alter them.

As behaviour is seen as being generated by thinking, the most logical and effective way of changing maladaptive behaviour is to change the maladaptive thinking underlying it.

Question 2

What does CBT involve?
Cognitive element

Answer 2

Cognitive element – The therapist encourages the client to become aware of faulty beliefs that contribute to their depression. This can involve direct questioning e.g. ‘Tell me what you think about…’

Question 3

What does CBT involve?
Behavioural element

Answer 3

Behavioural element – The therapist and client decide how the client’s beliefs can be reality tested through experimentation e.g. role play, homework assignments, encouraging the client to recognise the consequences of their faulty cognitions on their behaviour.

Question 4

What does CBT involve?
Homework

Answer 4

Homework:
Clients are asked to complete assignments between therapy sessions e.g. asking a person out on a date when they had been afraid to do so for fear of rejection – encouraging clients to make positive changes to their behaviour.
Homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice.

Question 5

Rational Emotional Behaviour Therapy (REBT)

Answer 5

Due to irrational thinking, individuals develop self-defeating habits because of faulty beliefs about themselves and the world around them.
The aim of therapy is reframing these irrational and negative thoughts into rational and positive ones.

Question 6

Ellis extended his ABC model to ABCDEF where:

Answer 6

• Disputing irrational thoughts and beliefs
• Effects of disputing
• Feelings (new emotions) that are produced

Question 7

REBT involves:

Answer 7

Logical disputing: self-defeating beliefs do not follow logically from the information available. (e.g. ‘Does thinking in this way make sense?’)
Empirical disputing: self-defeating beliefs may not be consistent with reality. (e.g. ‘Where is the proof that this belief is accurate?’)
Pragmatic disputing: emphasises the lack of usefulness of self-defeating beliefs. (e.g. ‘How is this belief likely to help me?’)

Question 8

Embling (2002) aim

Answer 8

Aim: To assess which types of patients benefit least and most from CBT.

Question 9

Embling (2002) procedure

Answer 9

Procedure:
An opportunity sample of 38 patients (19-65 years) diagnosed with depression.
Two groups were compared:
Control group: 19 patients receiving antidepressant medication (they were seen once a week for 10-20 minutes by a clinician who reviewed symptoms, side effects and provided advice).
Treatment group: 19 patients who received antidepressant medication in addition to 12 sessions of CBT over an 8 week period.
Patients completed dysfunctional thought records (DTRs) to monitor and record mood changes.
The Beck Depression Inventory (BDI) was used to assess the level of depression in all patients, both before and at one-week intervals throughout the study.

Question 10

Embling (2002) findings

Answer 10

Findings:
The treatment group’s mean BDI scores decreased over the course of the treatment, suggesting an improvement in symptoms, whereas the control group’s mean scores remained the same.
The treatment group expressed more negative emotions at the end of the study than the beginning , which is part of CBT’s success. Expressing negative emotions is necessary for recovery to occur.
Those who did not improve with CBT had high levels of sociotropy and perfectionism, low levels of autonomy and a high external locus of control.

Question 11

Embling (2002)conclusions

Answer 11

Conclusion:
CBT combined with drug therapy is more effective than drug therapy alone.
Personality characteristics affect CBT outcomes. People with high levels of autonomy, an internal locus of control and low levels of sociotropy benefit most from CBT.

Question 12

P:Research has shown the long-term benefits of REBT.

Answer 12

E:David et al. (2008) 170 patients suffering from major depressive disorder were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT (Cognitive Therapy), or 14 weeks of pharmacotherapy (fluoxetine).
It was found that patients treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine six months after treatment.
C:This suggests that REBT is a better long-term treatment than drug therapy.

Question 13

P:CBT is not an effective treatment for everyone.

Answer 13

E:CBT appears to be less suitable for:
People who lack the commitment and motivation to engage fully with the therapy.
People who have high levels of irrational beliefs that are both rigid and resistant to change.
Realistic stressors (i.e. irrational environments) in the person’s life that therapy cannot resolve.
People who have difficulty concentrating.
People who have difficulties talking about their inner feelings, or who don’t have the verbal skills to do so.
C:There are individual differences in the receptivity towards CBT.

Question 14

P:CBT is considered to be cost-effective

Answer 14

E:CBT empowers patients, providing them with self-sufficient and life-long coping strategies that they can continue to use long after the completing a course of CBT.
This is more cost-effective than drug treatment, where medication must continue even after improvements in mood have been achieved otherwise relapse may occur.

Question 15

P:The effectiveness of CBT also very much depends on the therapist.

Answer 15

E:For example:
The better trained the therapist, the better the therapeutic outcomes.
However, CBT can be too therapist centred, in that therapists may abuse their power of control over patients, forcing them into certain ways of thinking and patients can become too dependent on therapists.
C:Therefore, the success of CBT isn’t just dependent on the commitment and motivation of the client.