Treatments for Depression

Question 1

What is CBT?

Answer 1

• The underpinning notion behind CBT is that the individual’s thought processes are irrational/faulty and these faulty thought processes should be cognitively restructured in order to reflect reality accurately.
  -CBT was developed by Beck – he designed it to address the issues of the negative triad and the results of the negative schema, which develops during childhood.

1. Identify the irrational thoughts of self, future and/or world – known as thought catching.
2. Patient as a scientist – alongside the therapist the patient generates a hypothesis to test the validity
   of their irrational thoughts
3. Homework tasks are devised and worked upon between sessions
4. Reinforcement by therapist of positive thoughts occurs during sessions and upon reflecting on the
   homework tasks
5. Cognitive restructuring occurs, replacing the faulty thinking with accurate, positive thinking.

Question 2

What is Ellis’ Rational Emotional Behaviour Therapy (REBT)?

Answer 2

-A form of CBT that assumes that depression is caused by the irrational beliefs and aims to replace these irrational beliefs with rational beliefs and constructive behaviour.
-This therapy does not attempt to change the events that happen to someone, it aims to change
the way in which a client interprets the events.

Question 3

Whats the theory and therapy of CBT?

Answer 3

Theory
A – Activating Events that lead to interpretation of the meaning of that event.
B – Belief about the event or adversity
C – Consequences – usually emotional

Therapy
D - Disputing – disputing means questioning and challenging. Here, irrational beliefs are disputed.
E - Effects –the effects that the disputing of the irrational beliefs has on the client’s attitude to life.
F - Feelings – these are the new feeling (emotions) that are produced.

Question 4

What are the stages of REBT?

Answer 4

1. Logical disputing – challenging whether beliefs make sense. For instance,
   Does your partner leaving you really/logically mean that you are worthless?
   Does failure in an exam really/logically require suicide?
2. Empirical disputing – challenging whether there is evidence for such belief. For instance,
   where is the proof that your partner leaving you means that you must be worthless? Where
   is the proof that your partner’s death means that your world must end?
3. Pragmatic disputing – challenging the benefits of beliefs. For instance:
   What are the benefits of constantly thinking negatively about an event?

Question 5

What are the effects and feelings of REBT?

Answer 5

Effects
The hope is that reality will challenge the client’s irrational beliefs and replace them with rational beliefs. A common symptom of depression is a change in activity level where the client stops engaging in their normal activities. A CBT technique is to encourage the client to get back to their previous level by engaging in pleasurable activities.

Feelings
The client should have now replaced their old feelings (faulty thinking) with logical and more positive feelings

Question 6

A03 - Research Support

Answer 6

-There is much research support to indicate that CBT and REBT, are effective, particularly when used in
conjunction with drug therapy.
- Fava et al’s (1998) findings support the effectiveness of CBT in reducing relapse rates for depression.
- They assigned depressives to one of two groups: (i) drugs followed by CBT or (ii) drugs followed by training on how to take their drugs.
-Using a two year follow up, only 25% of the CBT group had relapsed compared to 80% for the drug treatment.
-Hence, CBT can be affective in the avoidance of relapse when used with drug therapy. However, the study did not investigate the use of CBT alone questioning its effectiveness as a sole therapy for depression.

Question 7

A03 - Don’t address biological factors

Answer 7

• CBT/REBT do not address the biological explanation of depression.
• The recent “genome wide linkage study’, called the Depression Network Study, found that depression is thought to involve both genetic and environmental factors, with genetics playing a larger role in the type of depression that is severe and recurrent.
  -This could explain why drug therapy through SSRI’s (Selective Serotonin Reuptake Inhibitors) are
  effective in up to 60% of those taking them.
  -These further questions the use of CBT/REBT as a
  comprehensive therapy for all who suffer from depression.

Question 8

A03 - Patient Variations

Answer 8

-There is variation in the effectiveness of CBT from patient to patient.
-This may well be down to the individual.
-For instance, Elkin et al (1985) found that CBT was far less for patients who displayed high levels of
irrational beliefs that were rigid and resistant to change.
-Ellis (2001) suggested that some patients simply do
not like CBT because it requires a lot of effort to reflect and change their irrational beliefs. Instead, they simply want to share their worries with the therapist.
-Likewise, the effectiveness of CBT varies from patient to patient may not be simply due to the individual differences.

-Kuyken and Tsivrikos (2009) confirmed this in a
field study, suggesting that therapist competence led to a 15% variation in the effectiveness of the therapy.
Thus, the subjective nature of CBT/REBT in terms of delivery and response questions its effectiveness for all patients.