What Does CT for Depression Look Like? Flashcards
3 main propositions
1) access hypothesis: individuals can become aware of the content and process of their thinking
2) mediation hypothesis: thinking about events influences emotional and behavioral responses
3) change hypothesis: cognitions are knowable and mediate responses to situations, individuals can modify responses to events to be more useful/functional
CT theory: realist assumption
- realist assumption: there is an objective reality that exists independently of our awareness of it
- people can come to know the world more accurately
- in general, good mental health = appraising world more accurate
- CT also cares about how useful cognitions are
CT theory: exploration, examination, experimentation
therapists help patients become scientific observers of thinking and view thoughts not as reality but as hypotheses
therapeutic principles
1) collaborative empiricism - patient and therapist as co-investigators
2) guided discovery - therapist helps patient test their own thinking
3) socratic dialogue - guided discovery technique using a series of deliberate and sequenced questions
Case conceptualization
evolving, collaborative process b/w therapist and client that synthesizes theory, evidence, and practice to generate hypotheses about the causes and mechanisms that maintains a person’s psychopathology and problems
- functions to guide therapy
CBT treatment plan for depression
1) assessment
2) psychoeducation
3) set treatment goals
4) behavioral activation/ other behavioral interventions
5) cognitive intervention - automatic thoughts, assumptions, core beliefs and schemas
6) relapse prevention
treatment plan: behavioral activation
monitor daily activities and emotions and assess links, monitor mastery and pleasure and identify deficits, generate and schedule activities
treatment plan: cognitive interventions
psychoeducation, identifying thoughts (3 column thought record), identifying cognitive distortions, challenging thoughts (6 column thought record), identifying underlying maladaptive assumptions and core beliefs and changing them
treatment plan: relapse prevention
goal is to identify potential stressors and prevent a small lapse from leading into a full relapse
cognitive technique: psychoeducation about the role of thoughts in emotions and behaviors
- the same situation can be interpreted in different ways
- different interpretations will lead to different emotional responses and behavioral consequences
- often we can’t know the correct interpretation, but which are more likely to be more accurate and useful
cognitive technique: evidence gathering
lawyer in court - is this admissable
therapist uses socratic questioning to help client generate additional evidence
cognitive technique: cost-benefit analysis
taking a thought and then writing out the costs/benefits of having that thought
other cognitive techniques
third-person perspective, self-compassion, humor, identifying positive aspects of thought, finding grey area in black and white thinking
cognitive technique: working with core beliefs and schemas
towards end of therapy
psychoeducation
identify beliefs and schemas - look for themes in thought record
cognitive technqiue: changing core beliefs/schemas
evidence gathering, cost/benefit of schemas and beliefs, recognizing continua, behavioral experiments, changing past narratives, imagining the new self, acting “as if”
Early studies of efficacy - CT vs Meds
outpatients with MDD randomly assigned to meds or CT
CT> meds for reduction of symptoms on BDI
CT group was less depressed at end
BUT med dosage was inadequate and meds were tapered, raters not blind to treatment condition
CT for depression course
Phase I (sessions 1-5): psychoeducation, goal setting, emphasis on behavioral change
Phase II (sessions 5-15): emphasis on negative automatic thoughts
Phase III (15-20): emphasis on identifying and changing core beliefs
termination/ relapse prevention
booster sessions
Early studies of efficacy : CT, Meds, or both
- CT and meds > than Ct or meds alone
- 6 month follow up, CT group had lower rates of relapse than meds
- several other studies have found that CT = meds for treatment of depression
Efficacy of CT: moderate to severe MDD
RCT - meds and CT are superior to placebo, with no different between meds and CT
Meta-analysis of EfT
combination of CT and meds superior to meds alone
CBT is efficacious for depression
effect of CBT may be overestimated due to publication bias
no difference between CT and meds in direct fcomparisons
no difference between CT and other psychotherapies
Long term effects of CT
lower MDD relapse rates with CT and CBT and meds than meds alone, in some studies shows no difference between CT and meds vs CT alone
Efficacy of CT in naturalistic setting
community mental health center, training for therapists, comparison of patients before and after therapist training
results: patient’s showed large decline in anxiety with CBT
CT in research vs. clinical setting
clients in RCT did almost 3x as better in RCT vs outpatient setting (decline in BDI score)
why?
axis II differences, patient motivation, therapist supervision, being videotaped, greater adherence, medication use, time limited
Effect of HW in CT
meta-analysis of the relationship between homework and CBT showed that patients with homework have better outcomes
