Cognitive Approach to Treating Depression

• Cognitive Behavioural Therapy (CBT)

  treatment will encourage patient to challenge these dysfunctional thoughts and replace them with rational and adaptive thinking

  cognitive therapy developed into CBT as it also involves behavioural changes such as learning coping strategies and becoming more active and engaging in behaviours and activities previously enjoyed

  CBT starts with an assessment during which the patient and therapist work together to clarify the patient's problems, establish a relationship and identify goals for the therapy.

  Beck and Ellis developed their own versions of CBT
• Ellis' Rational Emotive Behavioural Therapy (REBT)

  developed based on his ABC model of how psychological problems emerge. therapist and client work together to identify situations and irrational beliefs they produce

  patient is encouraged to dispute their beliefs where they're encouraged to think the self-defeating belief isn't consistent with reality.

  technique also includes logical disputing to point out the irrational belief doesn't follow logically from info available

  ABCDE model

  D = 'dispute'

  E = 'effects/effective
• Beck's Cognitive Behavioural Therapy

  patients make a record of their thoughts and together they identify the negative triad. therapist then challenges these dysfunctional cognitions by drawing attention to positive incidents or examples which contradict the negative assumptions

  called reality testing, comparing the irrational cognitions to the real world.

  technique also uses behavioural techniques as homework assignments to encourage positive behaviour such as helping a person with depression to set small goals to be achieved, such as getting out of bed
• Strength - CBT effectiveness in treating depression

  March et al compared effects of CBT with antidepressant drugs as well as a combination of the two

  After 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of both were significantly improved.

  CBT was shown to be just as effective as drug therapy in treating depression
• Strength - CBT deals with actual cause

  can make a real change in a patient's thinking style and behaviour meaning it will allow them to adapt to future events without triggering depression.

  makes it a long-term and therefore effective treatment that's curative as opposed to palliative.

  the idea that it's a long term treatment is supported by low relapse rates up 2yrs after therapy, in comparison to antidepressants (Hensley et al)
• Weakness - more appropriate for some individuals than others

  requires motivation to attend and take part in the sessions and people with severe depression may struggle with this requirement.

  it would be appropriate for these individuals to start treatment with antidepressants to help increase motivation levels.

  some people with rigid attitudes who are resistant to change don't benefit from CBT (Simon et al)

  so, CBT isn't suitable or effective for all individuals
• Weakness - risk of focussing only on changing thought patterns

  this ignores other environmental circumstances which may be causing/triggering the depression.

  e.g. a patient suffering from abuse would benefit from changing their circumstances and therefore an emphasis on changing their thinking may not be a long-term solution to that person's mental health problems
• Weakness - only be effective depending on competence of therapist

  Kuyken and Tsivrikos found that not only did the outcome of the therapy vary with low complex the depression was, it also depended on the competency of the therapist suggesting that it's not always not fully effective
• Weakness - CBT isn't as risk free as first thought

  often argued CBT as a treatment for depression is free of side effects.

  lack of risk to the client is commonly used to justify the use of CBT over drug therapy, as antidepressants can have unpleasant physical side effects.

  however, recent research has suggested that adverse effects - including distress, deterioration and family-relationship-strain - weren't uncommon in clients receiving CBT, especially when the therapy was delivered over a long period of time

  could be argued that CBT isn't as risk free as first thought.