The Cognitive Approach to Treating Depression

• Cognitive Behavioural Therapy (CBT)


  • Umbrella term for therapies used to treat depression, including Beck’s cognitive behavioural therapy and Ellis’s Rational Emotive Behavioural Therapy (REBT).
  • Central idea is to identify, challenge, and modify negative thoughts and cognitive biases to alleviate depression. Also aims to alter dysfunctional behaviours by establishing links between thoughts, feelings, actions, and symptoms
• • Thought Catching
  • Depressed individuals are taught to identify negative thoughts and understand the link between their thoughts and emotions.
  • Homework assignments may include recording emotion-arousing situations with automatic negative thinking for targeting in therapy.
• Cognitive Restructuring

  • Therapists help clients challenge negative and irrational thoughts, replacing them with more positive and rational thinking to alleviate depressive symptoms.
  • Patients are given homework assignments to act like a scientist, testing the reality of their irrational beliefs and keeping a diary of evidence to compare against negative thoughts.
• Behavioural Strategies (Behavioural Activation)

  • In CBT and REBT, depressed individuals are encouraged to identify pleasurable activities they previously enjoyed.
  • Therapists help clients overcome obstacles to engaging in these activities.
  • Graded homework assignments are given to experiment with chosen activities and engage in progressively more rewarding activities.
• Ellis’ Rational Emotive Behavioural Therapy

  • Ellis' Rational Emotive Behavioural Therapy (REBT) uses disputing as an effective strategy to challenge irrational thoughts in treating depression.
  • Effective disputing transforms self-defeating beliefs into more rational beliefs, leading to a healthier interpretation of events and helping the client feel more positive and self-accepting.
• Methods of Disputing

  • Empirical disputing involves the depressed client questioning the consistency of their beliefs with reality and seeking evidence for the negative thoughts.
  • Logical disputing entails the therapist questioning whether the irrational beliefs logically follow from the available information and whether they make common sense.
  • Pragmatic disputing requires the depressed client to question the usefulness of the negative thoughts and consider how they help or hinder their emotional well-being.
• Support for the effectiveness of CBT

  • March (2007) conducted a study comparing the effects of CBT, 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 86% of the combined group showed significant improvement, indicating the effectiveness of CBT in treating depression.
• Competence of Therapist

  • Kuyken (2009) found that as much as 15% of the variance in outcome may be attributed to therapist competence.
  • Therapists assessed as most competent had better patient outcomes regardless of the complexity of the case.
  • The effectiveness of CBT depends to some extent upon the training and skills of the therapist.
• Factors affecting the choice of treatment

  • CBT techniques are suitable for a wide range of situations and modes of delivery, including interactive software programs.
  • Successfully used with individuals of all ages, experiencing varying degrees of depression from mild to severe.
  • HOWEVER, in some cases of severe depression, patients may struggle to motivate themselves to engage in the cognitive work required by CBT.
  • Time constraints and financial costs of CBT compared to drug therapy need to be considered when evaluating its appropriateness for treating depression.
• Responses to CBT

  • CBT is difficult to predict which clients will respond well to it.
  • However, Simons (1995) found CBT to be ineffective for individuals with very rigid attitudes and resistance to change and effective for individuals with high stress levels due to long-term problems in their lives, as a brief treatment like CBT cannot resolve these issues.