Cognitive Approach in Treating Depression

• How does Cognitive Behaviour Therapy work?

  Managing Faulty Cognitions - Thought Catching

  Introducing Better Behaviours - Behavioural Activation
• What are 2 types of therapies based of the Cognitive Explanations

  1. Cognitive Behavioural Therapy
  2. REBT
• What is Cognitive Behavioural Therapy based on

  This is the modern psychological approach to therapy and it takes the strongest elements from both cognitive and behavioural approach
• What is REBT

  It is a type of CBT
• What does REBT stand for?

  RATIONAL Emotive Behaviour Therapy
• What does REBT challenge?

  Irrational beliefs or thought processes
• What does CBT do?

  It adapts a singular explanations into more practical and applicable understanding process and perception of environmental stimuli
• What does the therapy aim to do?

  Replace irrational thoughts with positive adaptive thinking.
• What does CBT identify?

  Identify thought process
• What does CBT aim to Implement?

  Positive Coping Mechanisms
• What are the 2 processes outside the Clinic?

  • Thought Catching
  • Behavioural Activations
• What is the process of Thought Catching?

  1. Identify the link between thinking and acting.
  2. Homework - Be aware of emotion-arousal link
  3. Record negative thoughts
  4. Challenge the negative thought with the realistic version/thoughts.
• What is the Behavioural Activation?

  - Together with the therapist and client set out a series of positive actions which may lead to reward.

  - Behavioural activation helps us understand how behaviours may influence emotions.
• What makes CBT different from other Therapies?

  1. Collaborative
  2. Time Limited
  3. Symptom Focused
• What does it mean that CBT is collaborative?

  The client and therapist work together to help remove the symptoms. The therapist will share their opinion of the case with the client.
• What does it mean that CBT is time-limited?

  Therapist and client agree to a certain number of sessions.

  Limited sessions.

  12 - 18 weekly sessions but it can be less.
• What does it mean by CBT is symptom focused?

  Targeting specific symptoms or problems.

  • It does not generally involve analysis of event in the past
• What the the 3 components of CBT?

  Initial Assessment of Need

  Goal Setting

  Homework and Feedback
• What happens during Initial Assessment of Need?

  The patient and therapist identify the patients problems
• What happens during Goal Setting?

  The patient and therapist agree on a set of goals. Therapeutic plans are laid out and specific.

  Set of actions aimed at facilitating progress towards improvements in behaviour.
• What happens during Homework and Feedback?

  The therapist may set task or highlight opportunities for improvements.

  The client is normally asked to keep a diary of their cognitive cognitions which can be explored.

  The patient identifies their own irrational beliefs and prove themselves wrong.
• Research support Butler and Beck

  Butler and Beck 2000

  They combined 14 different meta-analysis which looked at the effectiveness of Beck's cognitive therapy.

  • 80% of adults benefited from the therapy.

  It is effective because it is more successful than drug therapy.

  CBT has lower relapse rate
• Butler and Beck Research Support Paragraph

  CBT is a treatment for depression and is strengthened by the fact that it has been found to be very effective.

  For example, Butler and Beck combined 14 meta-analysis and found that 80% of adults benefited from therapy and it was more successful than drug therapy with a lower relapse rate.

  This demonstrates that CBT can be used to improve the quality of life for individuals with depression, the sample size suggests it is high in reliability therefore it can be used as credible evidence that CBT is an effective treatment for depression.
• Research Support - March

  March 2007: CBT is as good as drugs.

  SSRIs can cause suicidal tendencies in adolescents.

  CBT is seemingly a more appropriate therapeutic intervention.

  Studied 327 Adolescents with Depression.
• March 2007 Findings

  SSRIs - After 12 weeks: 62% - After 36 weeks: 81%

  CBT - After 12 weeks: 48% - After 36 weeks: 81%

  Combination of 2 - After 12 weeks: 73% - After 36 weeks: 86%
• Thase 2007

  Cognitive therapy is as effective in treating depression compared to anti-depressant drugs.

  However, it is a better because it is more acceptable to the patients.
• Research - Contradictory Evidence: Elkin

  Elkin 1985 found the CBT is less effective on those with extreme or rigid beliefs.
• What is REBT based on?

  Ellis ABC model
• How many new components did Ellis add

  2 components
• What are the 2 new components?

  Disputing Phase

  Effective Behaviour
• What happens during the Disputing Phase?

  Disputing phase [D] In disputing the irrational belief and attempting to challenge maladaptive assumptions.

  • The process of disputing gives the subjects the opportunity to challenge their thoughts moving them away from the catastrophic thoughts.

  The therapist can deploy a range of different techniques: 

  • Logical disputing analyses the relationship between beliefs and facts.
  • Empirical disputing analyses the consistency for thoughts.
  • Pragmatic disputing analyses the usefulness of thoughts
• Effective Behaviour meaning of the process?

  Effective behaviour (E) is the final step, and therapy aims to achieve this step. At this stage, you have learned how to change your behaviours and can now resist future unhealthy beliefs.
• Research Support - Smith and Glass

  Smith and Glass 1977: Meta-Analysis of 375 studies and found that REBT was the second most successful therapy after Systematic Desensitisation.
• Research Support - Ellis

  Ellis 1957 - [Ellis Original Research] into REBT found that it had 90% success rate with a average of 27 treatments
• REBT: Effectiveness

  It has been consistently found to be one of the most effectiveness forms of therapy.

  Ellis 1957, REBT had a 90% success rate with an average of 27 treatments.

   

  Smith and Glass 1977 found that REBT was the second most successful therapy after systematic Desensitisation.

   

  Macaskill and Macaskill 1996 found that REBT treatment alongside chemotherapy increases the effectiveness of the chemotherapy [Depression]
• REBT: Appropriateness

  The subjective characteristics of REBT can raise ethical issues which are difficult to ignore:

  • Too directive: the therapist has the majority of the influence over the behaviour of the subject, is this empowerment or social control.
  • REBT forces us challenge and change our normal functioning.
  • But Alloy and Abraham (1979) believe that depressives are “sadder but wiser”, as they demonstrate that depressed people are more likely to be able to anticipate disaster than “normal” people.