treating depression (cognitive approach)
Cards (11)
- cognitive behaviour therapy (CBT)
- seeks to treat depression by identifying the depressed thought patterns and replacing them with alternate ones
- most common psychological treatment
- CBT = example of the cognitive approach to treatment, though it also includes behavioural
- cognitive = challenge negative, irrational thoughts
- behaviour = change behaviour so it is more effective
- client and therapist work together
- Beck = challenge negative thoughts
- aim is to identify negative thoughts about the self, the world and the future (the negative triad)
- these thoughts must be challenged by the client taking an active role in their treatment
- the 'client as scientist'
- clients are encouraged to test the reality of their irrational beliefs
- they might be set homework, eg = to record when they enjoyed an event (this is referred to as the 'client as scientist'
- in future sessions if clients say that no-one is nice to them, the therapist can produce this evidence to prove the client's beliefs are incorrect
- Ellis's REBT
- REBT extends the ABC model to an ABCDE model:
- D = dispute (challenge) irrational beliefs
- E = effect
- challenging irrational thoughts:
- a client might talk about how unlucky they have been or how unfair life is - a REBT therapist would identify this as utopianism and challenge it as irrational
- empirical argument = disputing whether there is evidence to support the irrational belief
- logical argument = disputing whether the negative thought actually follows from the facts
- behavioural activation
- as individuals become depressed = they tend to increasingly avoid difficult situations and become isolated (which maintains or worsens symptoms)
- the goal of behavioural activation = to work with depressed individuals to gradually decrease their avoidance and isolation AND increase their engagement in activities that have been shown to improve model
- eg = exercising, going out to dinner etc
- strength = evidence of effectiveness
- March et al = compared the effects of CBT with antidepressant drugs and combination of the two in 327 depressed adolescents
- after 36 weeks = 81% of CBT group, 81% of antidepressants group and 86% of CBT+antidepressants group were significantly improved
- means that there is a good case for making CBT the first choice of treatment in public health care systems like the NHS
- limitation = suitability for diverse clients
- in severe cases = depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT (they may not even be able to pay attention in a session)
- Sturney = suggest that any form of psychotherapy (including CBT) is not suitable for people with learning difficulties
- means that CBT may only be appropriate for a specific range of clients
- ALSO = effectiveness of therapy may be down to the quality of rapport between therapist and client
- counterpoint to suitability for diverse clients
- Lewis and Lewis = concluded that CBT was as effective as other treatments for severe depression
- Taylor et al = concluded that CBT can be effective for people with learning disabilities
- means that CBT may have much wider application than once thought
- limitation = high relapse rates
- few early studies looked at long-term effectiveness
- recent studies suggest that relapse is common
- Ali et al = assessed depression for 12 months following a course of CBT
- 42% relapse within 6 months of ending treatment and 53% within a year
- means that CBT may need to be repeated periodically
- extra evaluation = client preference
- there is a large body of evidence to show that, used appropriately, CBT is highly effective (at least in the short term) in tackling symptoms of depression
- HOWEVER = some clients prefer to take medication or explore the past = some rate CBT as least preferred therapy
- suggests that people (even those who are depressed) should have the right to choose their therapy, even if it may not be the one with the best evidence of effectiveness