Treatments for depression

• Cognitive behavioural therapy (CBT)

  • CBT is the most commonly used psychological treatment for depression, as well as other mental health problems (e.g. anxiety, panic, phobias, stress, bulimia, OCD, Post-Traumatic Stress Disorder, bipolar disorder, etc.)
  • This is a method for treating mental disorders based on both behavioural and cognitive techniques
  • The therapist aims to make the client aware of the relationship between thought, emotion and actions

  CBT can help people to change how they think (‘cognitive') and what they do (‘behaviour'). These changes can help them to feel better.
• Cognitive behavioural therapy (CBT)

  It is a way of talking (psychotherapy) about:

  • how you think about yourself, the world and other people 
  • how what you do affects your thoughts and feelings.

  From the cognitive point of view therapy aims to deal with the thinking, such as challenging negative thoughts

  The therapy also includes behavioural techniques such as behavioural activation (encouraging patients to engage in those activities they are avoiding)
• Cognitive behavioural therapy (CBT)

  • CBT can help to break the vicious cycle of maladaptive thinking, feelings and behaviour. 
  • It focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve the state of mind now.
  • When the parts of the sequence are clearly outlined and understood, they can be changed. 

  CBT aims to get the person to a point where they can ‘DIY', and work out their own ways of tackling their problems.
• What does CBT involve?

  The Sessions

  Meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. 

  Each session will last between 30 and 60 minutes.
• Beck’s cognitive therapy

  Beck developed a therapy to challenge the negative triad (beliefs) of the client. To feel better you must think positively!

  1. First, the client will be assessed to discover the severity of their condition.  
  2. The therapist will establish a baseline (or starting point), prior to treatment, to help monitor improvement.  
  3. The client is asked to provide information about how they perceive themselves, the future and the world. 
• Beck’s cognitive therapy

  4. The therapist would use a process of reality testing e.g. if the client says, ‘I’m useless, and I always fail’, they will be asked whether in reality, they have been successful at something. The therapist might also ask the client to do something to demonstrate their ability to succeed.

  5. Clients are made aware of their negative views. In this way, irrational ideas can be replaced with more optimistic and rational beliefs.
• Ellis’ Rational Emotive Behaviour Therapy 

  REBT extends the ABC model to an ABCDE model

  D = Dispute (challenge the thoughts)

  E = Effect (see a more beneficial effect on thought and behaviour)

  Therefore the central technique of REBT is to identify and dispute the patient’s irrational thoughts
• Ellis’ Rational Emotive Behaviour Therapy 

  • Ellis (1962) argues that irrational thoughts are the main cause of all types of emotional distress and behaviour disorders.

  REBT is based on the premise that whenever we become upset, it is not the events taking place in our lives that upset us; it is the beliefs that we hold that cause us to become depressed, anxious, enraged, etc.
• Evaluation - effectiveness

  Effective

  • CBT is effective in reducing symptoms of depression and in preventing relapse and there is a large body of evidence to support this (March et al, 2007)
  • It is the most effective psychological treatment for moderate depression. 

  It is as effective as antidepressants for many types of depression (Fava et al, 1994).
• Evaluation - effectiveness

  Not effective

  • In some cases depression may be so severe that patients cannot motivate themselves to engage in the therapy 
  • In these cases, it is possible to treat the patient with antidepressants and then CBT can commence at a later date

  This is therefore a limitation as it means that CBT cannot be used as the sole treatment in all cases
• Other evaluation 

  Success may be due to the therapist-patient relationship

  • Research has shown that there is little difference between CBT and other forms of psychotherapy
  • It may be the quality of the therapist-patient relationship that makes the difference to the success of the treatment rather than the treatment itself

  Simply having the opportunity to talk to someone who will listen could be what matters most
• Other evaluation 

  Some patients may want to explore their past

  • CBT focuses on the ‘here and now’ however there may be links to childhood experiences and current depression and patients might want to talk about these experiences 

  They can find this ‘present-focus’ very frustrating
• Other evaluation 

  An over emphasis on cognition

  • There is a risk that in focusing on what is happening in the mind of the individual may end up minimising the importance of the circumstances the individual is living in

  There is thus an ethical issue for cognitive behavioural therapists here, and it is important for therapists to keep in mind that not all problems are in the mind