Treating depression:

• Who was the first person to develop a form of CBT?

  • Albert Ellis (in the 1950s) was one of the first psychologists to develop a form of CBT.
  • He first called it 'rational therapy' to emphasise the fact that, as he saw it, psychological problems occur as a result of rational thinking- individuals frequently develop self-defeating habits because of faulty beliefs about themselves and the world around them.
  • The aim of the therapy is to turn these irrational thoughts into rational ones
• What did ellis update his model to?

  Ellis added three new letters to his model where:

  • D refers to Disputing irrational thoughts and beliefs
  • E stands for the Effects of disputing and Effective attitude to life
  • F stands for the new Feelings (emotions) that are produced
• What is Ellis' aim of CBT/REBT?

  • To challenge irrational thoughts and beliefs
  • A client might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism and challenge it as irrational

  1. empirical argument- disputing whether there is evidence to support the irrational belief
  2. Logical argument- disputing whether the negative thought actually follows from the facts
  3. Pragmatic argument- emphasises the lack of usefulness of self-defeating beliefs
• What did Beck believe about CBT?

  • The 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 the scientist':

  • Clients are encouraged to test the reality of their irrational beliefs
  • They might be set homework, e.g. to record when they enjoyed an event. This is referred to as the 'client as the scientist'
  • In future sessions if the client say that no one is nice to the,, the therapist can produce this evidence to prove the client's beliefs are incorrect
• What is 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, therefore, is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood, e.g. exercising, going out to dinner, etc...
• What is unconditional positive regard?

  Ellis (1994) came to recognise that an important ingredient in successful therapy was convincing the client of their value as a human being. If the client feels worthless, they will be less willing to consider changing their beliefs and behaviour. However, if the therapist provides respect and appreciation regardless of what the does and says, this will facilitate a change in beliefs and attitudes.
• Strength of the cognitive approach in treating depression:

  • Evidence: March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a main diagnosis of depression. After 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 81% of the combined group were significantly improved.
  • This suggests that there is a good case for making CBT first choice for treatment, as it is effective in reducing symptoms.
• Limitation of the cognitive approach in treating depression:

  • Evidence: CBT appears to be less suitable for people who have high levels or irrational beliefs that are both rigid and resistant to change (Elkin et al, 1985). It is also less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person's life that therapy cannot resolve.
  • This suggests that CBT is more suitable for some individuals than others and that individual differences will affect its effectiveness
• Another strength:

  • Evidence: Babyak et al (2000) studied 156 adult volunteers diagnosed with a major depressive disorder. They were randomly assigned to a 4-month course of aerobic exercise, drug treatment or a combination of the two. After 4 months, all exhibited significant improvement. 6 months after the end of the study, those in the exercise group have significantly lower rates of relapse than those in the drug group.
  • This suggests that a change in behaviour (i.e physical activity) can be beneficial in treating depression and therefore supports the role of behavioural activation in REBT
• Limitation:

  • Evidence: Drug therapies have the strength of requiring less effort on the part of the client (ellis required 27 sessions of REBT which is a lot of commitment) Antidepressants such as SSRIs may be much more appropriate in more severe cases of depression. Research has also found that CBT is especially effective when used in conjunction with drug therapy
  • This suggests that there are alternative treatments which may be a better option for some individuals or may increase the effectiveness of CBT