Treating depression

• What is cognitive behavioural therapy as a treatment for depression?

  • A method for treating mental disorders based on cognitive and behavioural techniques
  • Aims to deal with irrational thinking and challenging negative thoughts by replacing them with positive ones
  • Seeks to tackle maladaptive behaviour, encouraging patients to test their irrational beliefs through behavioural experiments and homework
• What is Beck's cognitive therapy?

  • Identify automatic thoughts about the world, self, and future (Beck's negative triad) and challenge these
  • Helps clients test the reality of these beliefs by setting homework, like recording an event where people were nice to them to refer back to if they think nobody likes them, proving themselves incorrect
  • Known as 'client as scientist'
• What is Ellis' rational emotive behaviour therapy? (1)

  • Extends the ABC model to ABCDE model, dispute and effect
  • Dispute happens through vigorous arguments where therapists show unconditional positive regard
  • Empirical disputing: whether there is actual evidence to support the negative belief
  • Logical disputing: whether the negative thought logically follows from facts
  • Pragmatic disputing: whether it is useful to think/feel certain ways
• What is Ellis' rational emotive behaviour therapy? (2)

  • Dispute leads to Effective change in thoughts and feelings
  • Intended effect is to change the irrational belief and break the link between negative life events and depression
  • Depressed individuals become isolated by avoiding difficult situations -> maintains or worsens symptoms
  • Behavioural action: working to gradually decrease avoidance and isolation by increasing engagement in mood improving activities i.e. exercise
• What is one strength of cognitive treatments for depression?

  • Research support for effectiveness: March et al. (2007) compared CBT to antidepressant drugs and to a combination of both when treating 327 depressed adolescents
  • After 36 weeks, 81% of the CBT group, 81% of the drugs group, and 86% of the combination group were significantly improved
  • Shows CBT is just effective alone and more so when used alongside other treatments, showing its' real-world value
• What is one limitation of cognitive treatments for depression?

  • Suitability for diverse clients: lack of effectiveness for severe cases and clients with learning disabilities
  • Some cases can be so severe there is a lack of motivation to engage with the cognitive work of CBT and may not even be able to pay attention
  • Clients with learning disabilities may have difficulty engaging in the complex rational thinking that the therapy involves
  • Suggests CBT may only be appropriate for a specific range of people with depression, limiting its' effectiveness
• What is another limitation of cognitive treatments for depression?

  • High relapse rates: although CBT can tackle the symptoms of depression there are concerns over how long the benefits last - recent studies suggest long-term outcomes aren't as good
  • Shehzad Ali et al. (2017) assessed depression in 439 clients every month a year following a course of CBT
  • 42% of clients relapsed within 6 months and 53% within a year
  • Means CBT may need to be repeated periodically
• What is another limitation of cognitive treatments for depression?

  • Client preference: not all clients want to tackle their depression by identifying and changing unhelpful cognitive patterns
  • Some clients just want symptoms gone as quickly as possible and prefer medication
  • Others, like survivors of trauma, wish to explore the origins and root causes of their symptoms
  • Yrondi et al. (2015) found patients rated CBT their least preferred psychological therapy, meaning it isn't the most valued approach