The cognitve approach to treating depression Flashcards
What is cognitive behaviour therapy (CBT)?
CBT is the most commonly used psychological treatment for depression and a range of other mental health problems. If you see a clinical psychologist for a mental health problem, Theresa high chance you will receive CBT.
What does CBT begin with?
CBT begins with
an assessment in which the patient and the cognitive behaviour therapist work together to clarify the patient’s 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
What does CBT involve?
CBT involves working to change negative and irrational thoughts and finally put more effective behaviours into place. Some CBT therapist do this by using techniques from beck’s cognitive therapy, but some rely exclusively on ellis’s rational emotive behaviour therapy.
Most therapist use both.
What is CBT Becks cognitve therapy?
Cognitive therapy is the application of Becks theory of depression. 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 patients test the reality of their negative beliefs.
They might therefore be set homework such as to record when they enjoyed an event or when people were nice to them. This sometimes referred to as
the patient as scientist, investigating the reality of their negative beliefs in the way a scientist would . In future sessions if a patient says that no one is nice to them then the therapist can then produce evidence and use it to prove the patients statements are incorrect
What is CBT Ellis rational emotive behaviour therapy?
REBT extends to the ABC model to an ABCDE model - D stands for dispute and E for effect. The central technique of REBT is to identify and dispute irrational thoughts. For example, a patient might talk about how unlucky they have been or how unfair things seem.
an REBT therapist would identify these as example of utopianism and challenge this as an irrational belief this would involve a vigorous argument . The intended effect is to change the irrational belief and so break the link between negative life events and depression
this vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing. For example, empirical argument involves disputing whether there is actual evidence to support the negative belief.
logical argument involves disputing whether the negative thought logically follows from the facts.
What is behavioural activation?
Alongside the purely cognitive aspects of CBT the therapist may also work to encourage a depressed patient to be more active and engage in enjoyable activities. this behavioural activation will provide more evidence for the irrational nature of beliefs
How is it being effective a strength?
There is a large body of evidence to support the effectiveness of CBT for depression. For example a study by March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression. After 36 weeks 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group was significantly improved. thus CBT emerged as just as effective as medication and helpful alongside medication. This suggests there is a good case for making CBT the first choice of treatment in public health care systems like the national health service.
How is CBT may not work for the most severe cases a limitation?
In some cases depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. Although it is possible to work around this by using medication this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.
How is success may be due to the therapist- patient relationship a strength?
Rosenzweig (1936) suggested that the differences between different methods of psychotherapy such as CBT and systematic desensitisation might actually be quite small. All psychotherapies share one essential ingredient the therapist- patient relationship. It may be the quality of this relationship that determine success rather than any particular technique that is used. many comparative reviews ( eg. luborsky et al) find very small differences which supports the view that simply having an opportunity to talk to someone who will listen could be what matters most.
