The Cognitive Approach To Treating Depression Flashcards
Cognitive Behavioural Therapy
Most commonly used psychological treatment for depression and a range of other mental health issues.
It is an example of the cognitive approach to treatment, though it also includes behavioural elements.
Outline Cognitive Element of CBT
CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the clients problems.
They jointly identify goals for the therapy and put together a plan to achieve them.
One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
Outline Behavioural Element of CBT
CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place.
Beck’s Cognitive Therapy
The idea behind cognitive therapy is to identify automatic thoughts about the world, the self and the future — this is the negative triad.
Once identified these thoughts must be challenged — This is the central component of the therapy.
As well as challenging these thoughts directly, cognitive therapy aims to help clients test the reality of their negative beliefs — To help the client be more positive and rational.
CBT
AO3 — Weakness
Effectiveness
CBT is as effective as drug treatment in depression without the side effects.
It only works if the client truly gets involved and follows through the whole treatment.
CBT
AO3 — Strength
Effectiveness
March (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents.
After 36 weeks, CBT group (81%), antidepressants group (81%) and CBT plus antidepressants group (86%) 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.
CBT
AO3 — Weakness
Relapse Rates
Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last.
Some recent studies suggest that long-term outcomes are not as good as had been assumed. For example, Ali (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.
CBT
AO3 — Weakness
Suitability for diverse clients
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 thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities.
This suggests that CBT may only be appropriate for a specific range of people with depression.
Rational Emotive Behavioural Therapy —
ABCDE Model
Central technique is to identify and dispute irrational thoughts.
A- activating event.
B- belief about the event.
C- emotional consequences.
D- disputations to challenge beliefs.
E- effective new beliefs challenge irrational ones.
Rational Emotive Behavioural Therapy —
Process
The client and therapist decide together how the clients beliefs can be reality-tested through experimentation, either as role play or as homework assignments.
The aim is that clients become more self sufficient and better able to recognise the consequences of their faulty cognitions.
The client and therapist then set new goals for the client in order to be more realistic — Rational beliefs are incorporated into ways of thinking.
Behavioural Activation
As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.
The goal of behavioural activation is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood (exercising, going out to dinner).
The therapist aims to reinforce such activity.
REBT
AO3 — Strength
Lincon (1997)
Used a questionnaire on stroke victims who developed clinical depression.
19 patients were given CBT for 4 months.
They found that patients reported a reduction in symptoms which supports the idea that CBT reduces symptoms of depression.
However, this study used self reports which means participants could have been affected by social desirability effects and not reported the truth.
Yet this study is a naturally occurring phenomena and therefore more internally valid in its approach to researching depression.
REBT
AO3 — Strength
Embling (2002)
Used an opportunity sample of 38 patients — 19 patients were used as a control group who took antidepressants and had no CBT and other half had both antidepressants combined with CBT (12 sessions).
DV = Record dysfunctional thought records to record mood changes on a scale of 1-100 to rate emotions like anger and anxiety.
The treatment group expressed more negative emotions by the end of the treatment, which shows a success of CBT as they could express themselves.
Depressed patients are less likely to readily express negative emotions.
CBT combined with drug therapy is more effective than drug therapy alone.
REBT
AO3 — Strength
Embling (2002)
Evaluation
Lack of depressed emotions may be a causal factor rather than an effect of depression.
Improvement of the treatment group may be the fact they were seen more than the control group and for longer time than the control group.
