the cognitive approach to treating depression

Question 1

cognitive behaviour therapy

Answer 1

• the most commonly used psychological treatment for depression and other mental health problems

cognitive element - begins with an assessment where the client and therapist work together to clarify the problems, they identify goals and put together a plan, one central task is to identify where there may be negative or irrational thoughts

behaviour element - then involves working together to change negative and irrational thoughts, and then put more effective behaviours into place

Question 2

beck’s cognitive therapy

Answer 2

• cognitive therapy is the application of beck’s theory, the idea is to identify automatic thoughts about the world, the self and the future (negative triad)
• these thoughts must then be challenged
• also aims to help clients test the reality of their negative beliefs, they may be set tasks to do such as recording an event they enjoyed (client as scientist)
• the therapist can therefore use this as evidence to go against anything the client says in future sessions

beck’s steps -
1. identification and goal setting
2. skill acquisition, challenging, cognitive restructuring
3. application, client engages in behaviour between sessions in attempt to challenge negative thoughts

Question 3

ellis’s rational emotive behaviour therapy (REBT)

Answer 3

• REBT extends the ABC model to an ABCDE model, adding dispute and effect
• central technique of REBT is to identify and challenge irrational thoughts
• for example, client may talk about how unlucky they’ve been, this would be identified as utopianism, and would be challenged, involving a vigorous argument
• ellis identified different methods of disputing, empirical argument involves disputing whether there is evidence to support the negative belief, and logical argument involves disputing whether the negative thought logically follows from the facts
• reality testing, reminding client that there is no evidence to support their beliefs
• essential to trust and respect therapist and form a good relationship, helps client to tolerate the attack on their beliefs

example -
A - being dumped by partner
B - i am unattractive, unlovable, never going to find anyone else
C - depression
D - what is the evidence to the beliefs
E - rational, realistic thinking

Question 4

behavioural activation

Answer 4

• as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated
• behavioural activation aims to gradually decrease avoidance and isolation, and increase engagement in activities that have been shown to improve mood
• doing this gains some reward, reinforces more social behaviour which helps to challenge negative thoughts

Question 5

evaluation - evidence for effectiveness

Answer 5

• John March compared CBT to antidepressant drugs as well as a combination of both, after 36 weeks 81% of the CBT group, 81% of the antidepressant group and 86% of the combination group had significantly improved
• CBT was just as effective when used on its own, and more so when used alongside drugs due to helping both cognitions and biological components
• CBT is widely seen as the first choice of treatment in public healthcare systems such as the NHS
• large sample, 327 adolescents

Question 6

evaluation - suitability for diverse clients

Answer 6

• limitation is lack of effectiveness for severe cases, and for clients with learning disabilities
• depression may be so severe that clients cannot motivate themselves to engage with CBT, may not be able to pay attention, have to be able to build the relationship with the therapist, being able to do behavioural activation tasks
• Peter Sturmey sugested that any form of psychotherapy is not suitable for those with learning disabilities
• CBT may only be appropriate for a specific range of people with depression, antidepressants may work better

Question 7

evaluation - relapse rates

Answer 7

• limitation is high relapse rates
• CBT is effective in tackling the symptoms, but there is concern over how long the benefits last
• studies suggest that long-term outcomes are not as good as had been assumed
• Shehzad Ali assessed depression every month for a year following CBT, 42% of clients relapsed into depression within 6 months, 53% within a year
• CBT may need to be repeated periodically
• doesn’t deal with root cause of depression, such as biology, not a long term behavioural change