The cognitive approach to treating depression

• AO1 - CBT

  • CBT is the most commonly used psychological treatment for depression and other mental health issues.
  • Cognitive approach to treatment, with behavioural elements.
  • Cognitive element: challenges negative, irrational thoughts.
  • Behaviour element: changes behaviour so it‘s more effective.
  • Client and therapist work together.
• AO1 - Beck

  • Aimed to identify negative thoughts about the self, the future, the world - the negative triad.
  • Thoughts must be challenged by client to show they are taking an active role in treatment.
• AO1 - ‘client as scientist’


  • May be set homework. E.g. record when people are nice to them.
  • In future sessions, if client says no one is nice to them, the therapist can use this as evidence to prove the client’s statements are incorrect.
• AO1 - Ellis

  • Rational emotive behaviour therapy (REBT) extends to the ABCDE model.
  • D = dispute.
  • E = effect.
  • Central technique of REBT is to identify and dispute (challenge) irrational thoughts.
• AO1 - Utopianism

  • E.g. a client may talk about how unlucky they are.
  • A REBT therapist would identify this as utopianism and challenge this as an irrational behaviour.
  • Empirical argument: disputing whether there is evidence to support irrational belief.
  • Logical argument: disputing whether the negative thought actually follows from the facts.
• AO1 - behavioural activation

  • Depressed people tend to avoid difficult situations and isolate themselves which maintains or worsen symptoms.
  • Goal behavioural activation is to work with depressed people to gradually decrease their avoidance and isolation, and increase the engagement in activities that are shown to improve mood, e.g. exercise.
• AO3 - ✔️evidence of effectiveness 


  • Researchers compared the effects of CBT to antidepressant drugs, and a combination of both treatments.
  • After 36 weeks, 81% of the CBT group, 81% of the antidepressant group, and 86% of the combination group significantly improved.
  • Means that CBT is widely seen as the first choice of treatment in public healthcare systems, such as the NHS.
• AO3 - ✖️suitability for diverse clients


  • In severe cases of depression, clients can’t motivate themselves to engage with the cognitive work of CBT.
  • They may not even be able to concentrate in sessions.
  • Also likely that the complex rational thinking in CBT makes it unsuitable for treating depression in clients with learning disabilities.
  • Suggests that CBT may only be appropriate for a specific range of clients.
• AO3 - counterpoint; suitability for diverse clients

  • There is now evidence to challenge this.
  • Lewis and Lewis concluded that CBT was as effective as other treatments.
  • Taylor et al concluded that CBT can be effective for people with learning disabilities when used appropriately.
  • Means that CBT may have wider application than what was once thought.
• AO3 - ✖️high relapse rates


  • Although CBT is quite effective in attacking symptoms of depression, there are some concerns in how long benefits lasts.
  • Studies of CBT looked over long-term effectiveness and suggested that long-term outcomes are not as good as it had been assumed.
  • In one study, it assessed 439 clients with depression for 12 months of a course of CBT.
  • 42% relapsed within 6 months of ending treatment.
  • 53% relapsed within a year.
  • Means CBT may need to be repeated periodically.