CA To treating depression CBT

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  • Cognitive behavioural therapy (CBT) is the most commonly used psychological treatment for depression and a range of other mental health problems.
  • If you see a clinical psychologist for a mental health problem the chances are you will receive CBT. CBT begins with an assessment in which the patient and the cognitive behaviour therapist work together to clarify the patient’s problems. - They jointly identify goals for the therapy and put together a plan to achieve them.
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  • One of the central tasks is to identify where there might be negative or irrational thoughts that the patient can attempt to challenge. CBT then involves working to change the negative and irrational thoughts and finally put more effective behaviours into place.
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  There are two versions of CBT:

  • One is Beck’s CBT and one is Ellis’ version of CBT which is called rational emotive behaviour therapy (REBT). Some CBT therapists purely use Beck’s cognitive therapy, and some rely exclusively on Ellis’ rational emotive behaviour therapy (REBT). However, most draw on both of these versions of CBT.
• Beck’s version of CBT

  • Beck’s version of CBT applies his explanation of depression to treating depressed patients. The idea behind Beck’s CBT is to identify automatic negative thoughts about the world, the self and the future – this is the negative triad. Once identified, these thoughts must be challenged.
• Beck’s Version of CBT

  • By challenging these negative thoughts, the patient could gradually challenge their negative schema, so that they stop interpreting everything about themselves and their life in a negative way. This is the central component of CBT. As well as challenging these thoughts, Beck’s cognitive therapy also helps patients overcome their depression through homework, behavioural action and unconditional positive regard.
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  Homework

  • Clients are often asked to complete assignments between therapy sessions. E.g. asking someone out on a date when they had been afraid to do so before for fear of rejection, looking for a new job, etc.
  • Such homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice
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  Behavioural Action

  • CBT involves a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities.
  • This is based on the idea that being active leads to rewards that act as an antidote to depression
  • A characteristic of depressed people is that they no longer participate in activities they previously enjoyed
  • In CBT, the therapist and client identify potentially pleasurable activities and deal with

  any cognitive obstacles (e.g. ‘I won’t be able to achieve that’.)
• Features:

  Unconditional positive regard

  • An important factor in successful therapy is convincing the depressed client of their value as a human being
  • If a therapist provides respect and appreciation regardless of what the client does and says, this will lead to a change in the client’s beliefs and attitudes
• Ellis’ version of CBT: rational emotive behaviour therapy REBT:

  • In the 1950s, Ellis developed a form of CBT called rational emotive behaviour therapy (REBT). Ellis claimed that psychological problems were a result of irrational thinking – individuals develop self- defeating habits because of faulty beliefs about themselves/the world.
  • Ellis extended his ABC model to ABCDEF.

  The ABC model states that irrational beliefs about events leads to depression. Therefore, REBT focusses on challenging the irrational thoughts/beliefs and replacing them with effective/rational beliefs
• Ellis extended his ABC model to ABCDEF:

  • D: Disputing irrational thoughts – often involves a vigorous argument The REBT therapist would identify any irrational thoughts the patient may have . The therapist would then dispute and argue against this irrational belief in order to make the patient realise there is no evidence to support their irrational thought about never getting a job and that there are no facts to back this up.
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  • This argument is the most important stage of Ellis’ version of CBT, as this is where the therapist makes the patient realise they are not thinking rationally, which means the patient can begin to change their negative irrational thinking.
• ABCDEF:

  • E: Effects of disputing – this refers to the positive effects of disputing the patient’s irrational thoughts and the patient’s realisation that their negative thoughts are irrational.
  • F: Feelings – this refers to the new feelings (emotions) that are produced as a result of tackling the irrational thoughts (e.g. happiness).
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  Research support

  • One strength of CBT is the high success rate.
  • Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete treatment
  • However, he recognised the treatment was not always successful. He states that this may be because clients did not always put their new ‘rational’ beliefs into action
  • Cuijpers et al. (2013) also reviewed 75 studies and found that CBT was superior to having no treatment.
  • This suggests that CBT is an effective form of treatment for depression.
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  • One limitation of CBT is that it is not suitable for all individuals
  • CBT appears to be less effective for individuals who have high levels of irrational beliefs that are both rigid and resistant to change (Elkin et al. 1985)
  • Ellis explains this lack of success in terms of suitability – some people simply do not want the direct sort of advice that CBT therapists tend to give.
  • These people would rather share their worries with a therapist without getting involved in the cognitive effort that is needed for recovery.
  • This means CBT is suitable for some people but not others
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  • Research supports the behavioural activation component of CBT
  • Babyak et al. (2000) studied 156 adult volunteers diagnosed with depression
  • They were randomly assigned to a 4 month course of aerobic exercise, drug treatment or a combination of the two.
  • 6 months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group
  • This suggests that encouraging depressed clients to become more active (which is a key component of CBT) can help in treating depression
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  • limitation of CBT is that it requires more effort on the part of the client than other treatments.
  • E.g. Drug therapies (antidepressants) require less effort from the client than CBT
  • Drug therapies also take less time to treat depression than CBT (CBT can take 30 sessions)
  • However, Cuijpers et al found that CBT was especially effective if it was used in conjunction with drug therapies.
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  • This suggests that, although CBT alone may take a long time to treat the depression and requires a lot of effort from the client, the use of drugs alongside CBT can make it easier for the client to cope with the demands of the CBT and improves the overall effectiveness of the treatment.