Cognitive approach to treating depression

• Cognitive Behaviour Therapy

  Most common psychological treatment. CBT is an example of the cognitive approach to treatment, but also includes behavioural aspects. Client and therapist work together.

  • Cognitive: challenge negative, irrational thoughts.
  • Behavioural: change behaviour so it is more effective.
• Beck - challenge negative thoughts: aim is to identify negative thoughts about the world, self and future (the negative triad). Thoughts must be challenged by client taking an active role in treatment.
• 'Client as scientist': clients encouraged to test reality of their irrational beliefs. Clients might be set homework, e.g to record when they enjoyed an event, and when they make a irrational claim, therapist can produce this as evidence to disprove.
• Ellis's Rational Emotive Behaviour Therapy: REBT extends the ABC model to an ABCDE model:

  • Dispute irrational beliefs
  • Effect.
• Challenging irrational thoughts: An REBT therapist would identify irrational thoughts.

  • Empirical argument - disputing whether there is evidence to support irrational belief.
  • Logical argument - disputing whether negative thought actually follows from facts.
• Behavioural activation: working with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement.
• ++ Evidence of effectiveness. March et al. (2007) compared effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents. After 36 weeks, 81% of CBT group, 81% of antidepressant group and 86% of combination group significantly improved. There is a good case for making CBT the first choice of treatment in public health care systems.
• --Suitability for diverse clients. In severe cases, depressed clients may not be able to engage with the cognitive work of the CBT. Sturney (2005) suggests any form of psychotherapy not suitable for anyone with learning disabilities. This means that CBT may only be suitable for a specific range of clients.
• --High relapse rates. Ali et al.(2017) assessed depression for 12 months following a course of CBT. 42% relapsed within six months and 53% within a year. This means that CBT may need to be repeated periodically.
• --Client preference. Some clients prefer to take medication or explore the past. This suggests that people, even the depressed, should have the right to choose their treatment even if it isn't the one with the best evidence of effectiveness.