cognitive approach to treating depression

• Cognitive behaviour therapy (CBT)?

  A method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy also includes behavinral techniques such as behavioural activation.
• Irrational thoughts ?

  In Ellis's model and therapy, these are defined as thoughts that are likely to interfere with a person's happiness. Such dysfunctional thoughts lead to mental disorders such as depression
• One strength of CBT ?

  P - large body of evidence supporting its effectiveness for treating depression.

  E - Many studies show that CBT works. For example, March et al. (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. So CBT was just as effective when used on its own and more so when used alongside antidepressants. CBT is usually a fairly brief therapy requiring six to 12 sessions so it is also cost-effective.

  L - CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service.
• One limitation of CBT for depression?

  P - lack of effectiveness for severe cases and for clients with learning disabilities.

  E - In some cases depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities. Sturmey (2005) suggests that, in general, any form of psychotherapy is not suitable for people with learning disabilities, and this includes CBT.

  L - CBT may only be appropriate for a specific range of people with depression.
• Counterpoint ?

  P - more recent evidence that challenges this.

  E - A review by Lewis and Lewis (2016) concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression. Another review by Taylor et al. (2008) concluded that, when used appropriately, CBT is effective for people with learning disabilities.

  L - CBT may be suitable for a wider range of people than was once thought.
• further limitation of CBT for the treatment of depression ?

  P - high relapse rates.

  E - some concerns over how long the benefits last. Relatively few early studies of CBT for depression looked at long-term effectiveness. Some more recent studies suggest that long-term outcomes are not as good as had been assumed. For example in one study, Ali et al. 2017) assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.

  L - CBT may need to be repeated periodically.
• Cognitive element ?

  CBT begins with an assessment in which the client and cognitive behaviour therapist work together to clarify the clients problems. They identify goals and make plans in order to achieve them. One of the most important tasks is identifying which negative or irrational thoughts that will benefit from a challenge.
• Behaviour element ?

  CBT then involves working to change negative thoughts to put more effective behaviour in place. 
• becks cognitive therapy?

  • identify automatic thoughts about the world, the self and the future. This is called the negative triad. These thoughts must be challenged. 
  • helps the client test the reality of their negative thoughts. To help them they may be asked to give a time when they enjoyed an event. can be used in future when if the client says they haven’t enjoyed anything this can be used as evidence to show that they have.
  • taking them away from the faulty information processing as its moves their attention away from the negative aspects of life
• Ellis’s rational emotive behaviour therapy?

  • Rational emotive behaviour therapy extends the ABC model to ABCDE model where the D is for dispute and E stands for effect. The main aim is to identify and dispute any irrational thoughts.  
  • The different methods of disputing that Ellis discovered can be explained by these two examples. 

  1. empirical argument involves disputing whether or not there's actual evidence to support negative belief.
  2. logical argument involves disputing whether the negative belief logically follows from the facts. 
• how does Ellis’s rational emotive behaviour therapy work?

  1. Client says how unlucky and unfair things have been or may seem

  2. REBT therapist identifies these as examples of utopianism and challenge this as an irrational belief.

  3. Vigorous argument happens to change the irrational belief and break link between negative memories and depression. 

  4. The vigorous argument is hallmark of REBT and ellis has identified different methods of disputing. 
• behavioural activation?

  When individuals become depressed they tend to avoid difficult situations which worsens their symptoms as they become isolated. 

  The goal is to decrease depressed individuals from isolating and avoiding situations and it helps to increase their engagement in activities which helps them to get into a good mood. The therapist aims to reinforce such activity