Depression

• What is CBT (cognitive behavioural therapy) as a treatment for depression?

  • Based on cognitive and behavioural techniques
  • Aims to deal with irrational thinking and challenging negative thoughts by replacing them with positive ones
  • Seeks to tackle maladaptive behaviour, encouraging patients to test their beliefs through behavioural experiments and homework|
• How does CBT work?

  • Patient and therapist work together to identify problems - assessment
  • Jointly decide on goals and work to create a plan to achieve these and monitor behaviour
  • Identify negative and irrational thoughts which need to be challenged in order to create adaptive behaviour
  • Actively work to change these thoughts and put more effective behaviours into place e.g. writing in a diary
• What is Beck's cognitive therapy?

  • Central component of CBT - identifying and challenging the negative triad of thoughts (self, world, future)
  • Clients may be set homework i.e. to record an event they enjoyed or a time when someone was nice to them
  • Mainly used to prove that the clients' beliefs are irrational and have no basis in reality i.e. if client says no one is nice to them the therapist can use evidence to prove them incorrect
  • Known as 'client as scientist'
• What is Ellis' REBT (rational emotional behavioural therapy)?

  • Extends Ellis' ABC model to ABCDE
  • Dispute (challenging thoughts)
  • Effect (see a more beneficial effect on thought and behaviour)
• How do therapists dispute clients as a part of REBT?

  • Dispute happens through vigorous arguments where therapists must show unconditional positive regard
  • Empirical disputing: whether there is actual evidence to support the negative belief
  • Logical disputing: whether the negative thought logically follows from facts
  • Pragmatic disputing: whether it is useful to think/feel certain ways
• How do therapists go from dispute to effect as a part of REBT?What is behavioural action?

  • Dispute leads to Effective change in thoughts and feelings
  • Intended effect is to change the irrational belief and break the link between negative life events and depression
  • Depressed individuals become isolated by avoiding difficult situations -> maintains or worsens symptoms
  • Behavioural action: working to gradually decrease avoidance and isolation by increasing engagement in mood improving activities i.e. exercise
• What evidence is there for the effectiveness of treating depression?

  • March et al. (2007): compared using CBT to treat 327 depressed adolescents to antidepressants and a mixture of CBT and drugs
  • Found 81% of CBT group,. 81% of drugs group, and 86% of combination group were significantly improved
  • Shows CBT was just as effective when used alone as other treatments
  • Cost-effective as it is fairly brief, widely seen as first choice of treatment like the NHS showing its' real-world value
• How is CBT not suitable for diverse clients?

  • Some cases are so severe there is a lack of motivation to engage with the cognitive work of CBT - some may not even pay attention to the sessions
  • Sturmey (2005): requires complex rational thought, unsuitable for clients with learning disabilities like all other 'talking' therapies
  • Suggests CBT may only be appropriate for a specific range of people with depression
• Why does CBT have such high relapse rates?

  • Recent studies suggest long-term outcomes are not as good
  • Shehzad Ali et al. (2007) - assessed depression in 439 clients every month for a year following a course of CBT
  • 53% relapsed within a year and 42% within 6 months
  • Means there is a lack of understanding that CBT may need to be repeated periodicially
• How does client preference weaken treatments of depression?

  • When used with appropriate clients, identifying and changing unhelpful patterns of behaviour and thinking is highly effective
  • BUT different people have different purposes - some want all their symptoms gone quickly and easily
  • Survivors of trauma may wish to explore the origins of their symptoms
  • Yrondi et al.: depressed people rate CBT as their least preferred psychological therapy