The Cognitive approach to treating depression

• What is the most common treatment for depression?

  • Cognitive behavioural therapy (CBT)
  • Came from umbrella term for treatments, e.g. ERP, REBT + TNAT
  • Initially Beck's (1960s) CBT
  • Beck's CBT = depression treatment only!
  • Applied thought behind Negative Triad
  • Aims to address faulty thinking/irrational beliefs underlying depression
• How does CBT work?

  • c.20 sessions over c.16 weeks
  • Assessment -> patient + therapist clarify problems
  • Joint plan -> goals + how to achieve them
  • Behavioural activation -> client re-uptakes activities that used to bring them joy prior to challenge of irrational thoughts
  • Homework -> 'thought catching'/tasks = evidence against irrational beliefs
  • Key aspect = disputing (challenging irrational thoughts) -> specifically NATs stemming from Negative Triad
• Cognitive approach to treating depression A&E point 1: CBT is effective

  • Ellis (1957) -> 90% effectiveness with c.27 sessions of REBT
  • March et al. (2007) -> CBT as effective in acute stage as antidepressants, but without side effects (patient outcome study)
  • 327 adolescents + 36 weeks treatment
  • 3 conditions -> CBT, drug therapy, CBT AND drug therapy
  • Improvement: CBT = 81%, drug therapy = 81%, CBT AND drug therapy = 86%
  • Holland et al. (2006) -> CBT = slightly greater residual effect
  • CBT = 40% relapse (moderate-severe depression) in 1 year
  • Drug therapy = 45% relapse; placebo = 80% relapse
• Cognitive approach to treating depression A&E point 3: an interactionist approach to treating depression may be more appropriate

  • Biological approach
  • March et al. (2007) -> improvement = CBT 81%, drug therapy 81%, CBT + drug therapy 86%
  • Psychodynamic approach
  • Barnes + Prosen (1985)
  • Bifulco et al. (1992)
  • -> childhood trauma linked to development of depression
  • Potential unresolved unconscious internal conflicts -> talking therapy needed = not cognitive!