Treating Depression

Question 1

Outline 3 characteristics of rational thoughts/ beliefs:

Answer 1

Based on reality where the individual is seeing things as they really are in the world.​

Allows the individual to achieve their goals/full potential.​

The individual experiences emotions that they can handle.​

Allows the individual to behave in ways which promote life goals and survival, (environmental mastery).

Question 2

Outline 2 characteristics of irrational thoughts/ beliefs:

Answer 2

Distorts your idea of reality​, (links to Beck’s ideas of negative schemas and cognitive biases).

It blocks/stops you from achieving your goals and life purposes, (deviation from the ideal mental health)​.

Creates extreme emotions which persist and cause extreme distress, (deviation from ideal mental health - suffering).
It can lead to behaviours that cause harm to yourself and others. ​

Question 3

What is CBT?

(Cognitive Behavioural Therapy​)

Answer 3

The main psychological treatment used to help treat depression; based on the cognitive model.​

Question 4

What is the central idea behind CBT?

Answer 4

Beliefs, expectations and cognitive assessments of the self, the environment, and the nature of personal problems affect how individuals perceive themselves and others, how problems are approached and how successful individuals are in coping and reaching goals.​

Question 5

How does CBT work?

Answer 5

By helping the patient to identify irrational and maladaptive thoughts and alter them.

Thoughts are perceived as affecting emotions and behaviour and so are modified to reduce depressive symptoms.

Question 6

What two elements are combined in CBT?

Answer 6

Cognitive therapy and behavioural therapy.​

Question 7

What is the basic notion of CBT?

Answer 7

The client needs to change, clarify and challenge his/her inappropriate behaviour and irrational thoughts.​

Question 8

CBT is an umbrella term for a number of different therapies. What are the two best known?

Answer 8

Rational Emotive Behaviour Therapy (REBT).

Treatment of Negative Automatic Thoughts (TNAT)​.

Question 9

What is the central idea of both TNAT and REBT?

Answer 9

To challenge and restructure maladaptive ways of thinking into adaptive, rational ones.

Question 10

In CBT, depression is seen as distorted…

Answer 10

Thought processes​.

Question 11

What is an interpretive bias?

Answer 11

An information-processing bias, the tendency to inappropriately analyse ambiguous stimuli, scenarios and events.

Question 12

What does TNAT stand for?

(Beck’s TNAT)

Answer 12

Treatment of Negative Automatic Thoughts.

Question 13

What is TNAT?

(Beck’s TNAT)

Answer 13

A form of CBT which involves reality testing.​

It is an active, directive therapy that focuses on the present, although in the initial session background information might be needed to throw light on the current circumstances.

Question 14

What did Beck state about treating depression?

(Beck’s TNAT)

Answer 14

It should be more than simply changing dysfunctional/irrational thoughts and replacing them with positive ones.​

Question 15

What does TNAT emphasise?

(Beck’s TNAT)

Answer 15

The use of homework assignments and hypothesis testing.​

Question 16

How long does TNAT treatment last?

(Beck’s TNAT)

Answer 16

Intended to be brief, consisting of about 20 sessions with a therapist over 16 weeks.

Question 17

What is TNAT based on?

(Beck’s TNAT)

Answer 17

Beck’s theory of depression.

Question 18

What does TNAT aim to do?

(Beck’s TNAT)

Answer 18

Identify and alter negative beliefs and expectations (the cognitive element) and to alter dysfunctional behaviours that contribute to or are maintaining the depression (the behavioural element).

Question 19

In order for a TNAT therapist to identify and alter negative beliefs and expectations, they must employ a range of suitable strategies. What are the 5 methods?

(Beck’s TNAT)

Answer 19

Behavioural activation.

Graded homework assignments.

Thought-catching.

Cognitive restructuring.

Problem solving.

Question 20

Outline behavioural activation as a strategy TNAT therapists use.

(Beck’s TNAT)

Answer 20

Encourages the client to identify pleasurable activities that they no longer participate in and to identify and overcome cognitive obstacles in carrying them out.

Question 21

Outline graded homework assignments as a strategy TNAT therapists use.

(Beck’s TNAT)

Answer 21

Allow the client to try out new ways of thinking and to engage in progressively more rewarding activities.

Question 22

Outline thought catching as a strategy TNAT therapists use.

(Beck’s TNAT)

Answer 22

The client is encouraged to record their automatic negative thoughts and generate thoughts of how they might challenge these.

Question 23

Outline cognitive restructuring as a strategy TNAT therapists use.

(Beck’s TNAT)

Answer 23

Restructuring negative thought processes to overcome cognitive distortions and biases.

Question 24

Outline problem solving as a strategy TNAT therapists use.

(Beck’s TNAT)

Answer 24

The client is taught ways of thinking more constructively about problems and solutions.

E.g. by using a systematic method to get at the root cause of the problem rather than making assumptions and flawed conclusion.

One method is the 5-step Kepner-Tregoe technique where the problem is defined, the problem is described, and possible causes are established. Probable causes are tested, and root causes are verified.

Question 25

What does REBT stand for?

(Ellis’ REBT)

Answer 25

Rational Emotive Behaviour Therapy.

Question 26

When was REBT proposed?

(Ellis’ REBT)

Answer 26

Proposed in the 1950s, but was modified by Ellis over a number of years until his death in 2007.​

Question 27

What did Ellis believe about depression?

(Ellis’ REBT)

Answer 27

Believed that the way people feel is influenced by how they think.

Ellis saw irrational thoughts as causing emotional distress and behaviour disorders.​

Question 28

How does REBT work?

(Ellis’ REBT)

Answer 28

By focusing on identifying irrational/ unhelpful thoughts and vigorously arguing against them; so they become more rational and positive.

Question 29

How does the therapist support the depressive in REBT?

(Ellis’ REBT)

Answer 29

By challenging the patient and help them to practise being positive and optimistic.​

Question 30

In REBT, the therapist challenges the patient, helping them to practise being positive and optimistic.​ This is done in four ways, state them.

(Ellis’ REBT)

Answer 30

Reframing.

Educational phase.

Behavioural activation and pleasant event scheduling.

Transformation phase - (not on spec).

Question 31

Outline reframing within REBT.

(Ellis’ REBT)

Answer 31

Challenging negative thoughts by reinterpreting them.​

Treatment is generally 1-2 sessions every two weeks for about 15 sessions.​

Therapist and client work together to verify reality.​

E.g. ‘I’m a poor parent, because my children misbehave’.

The therapist will get the patient to assess the truth in this statement.​

Question 32

Outline educational phase within REBT.

(Ellis’ REBT)

Answer 32

Patients learn about the relationship between thoughts, emotions, and behaviour.​

Question 33

Outline behavioural activation and pleasant event scheduling within REBT.

(Ellis’ REBT)

Answer 33

Increasing physiological activity and participation in social and other rewarding activities. ​

Once patients have experienced an improvement in mood or energy, this provides a good opportunity for the therapist to help the client to identify faulty thinking responsible for low mood and challenge these thoughts.​

Question 34

Outline the transformation phase within REBT.

(Ellis’ REBT)

Answer 34

Client sees the world differently.

They are able to use the learnt strategies freely within the real world.

Question 35

What is hypothesis testing?

(Ellis’ REBT)

Answer 35

Between sessions patients are given goals to boost self-esteem.​

These involve hypothesis testing of negative thoughts through behavioural coping skills​.

E.g. testing the belief that they’re incapable of being included in a conversation, by talking to strangers in social situations​.

Question 36

Give an example of changing an irrational thought into a rational thought.

(Ellis’ REBT)

Answer 36

‘If not done perfectly, there is no point in doing it’.

‘Don’t overthink, it is a learning process so be excited to try new things’.

Question 37

Give an example of changing an irrational emotion into a rational emotion.

(Ellis’ REBT)

Answer 37

‘I constantly worry’.

‘Be less apprehensive of getting things wrong, you don’t have to be perfect’.

Question 38

Give an example of changing an irrational behaviour into a rational behaviour.

(Ellis’ REBT)

Answer 38

‘I find it difficult to start anything, work is suffering’.

‘I should just try new things and have a go’.

Question 39

Outline Lincoln et al’s study from 1997.

(Supports CBT for the treatment of depression)
(AO3 for CBT)

Answer 39

Supports CBT for the treatment of depression.

This is because they used a questionnaire to identify stroke victims who have developed clinical depression.

19 patients were then given CBT sessions for 4 months, resulting in reduced symptoms.

This suggests that CBT is a suitable treatment for specific groups of depressives.

In this way it can also seem to challenge CBT, as it may not be fully effective for all patients.

Question 40

Outline The Department of Health’s study from 2001.

(Supports CBT as an effective treatment, but also challenges it’s singular effectiveness)
(AO3 for CBT)

Answer 40

Supports CBT as an effective treatment, but also challenges it’s singular effectiveness.

This is because they reviewed papers of treatments for depression, including behavioural, cognitive, humanistic, and psychotherapeutic ones; finding CBT to be the most effective.

However, they did not endorse the use of CBT alone, as other treatments like behavioural therapy, were effective too.

Question 41

Outline Hollon et al’s study from 2006.

(Supports CBT over drug therapy)
(AO3 for CBT)

Answer 41

Supports CBT over drug therapy.

This is because they found that 40% of moderately to severely depressed patients treated with CBT for 16 weeks relapsed within the following 12 months, compared to a relapse rate of 45% for patients treated for the same period with drug therapy.

This suggests that CBT is slightly more effective, long term, than drug therapy and much better than no treatment at all.