Cognitive approach to treating depression

• What is the most common psychological treatment for depression

  CBT - cognitive approach but includes behavioural aspects

  • cognitive - challenge, negative, irrational thoughts
  • behaviour - change behaviour so its more effective

  the client and therapist work together
• CBT: link to beck - challenging negative thoughts

  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
• CBT: the client as 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.
  • in future sessions if clients say that no one is nice to them, the therapist can produce this evidence to prove the clients beliefs are incorrect
• CBT: Ellis REBT

  REBT extends the ABC model to an ABCDE model

  • D for dispute (challenge) irrational belieds
  • E for effect
• CBT: challenging irrational thoughts

  a client might talk about how unlucky they have been and how unfair life is. a REBT therapist would identify this as Utopianism and challenge it as irrational

  • empirical argument - disputing whether there is evidence to support the irrational belief
  • logical argument - disputing whether the negative thought actually follows from the facts
• CBT: behavioural action

  as individuals become depressed, they tend to increasingly avoid difficult stations 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
• one strength of CBT is that there is evidence of effectiveness

  March (2007) compared the effects of CBT with antidepressant drugs and a combination of the 2 in 327 depressed adolescents. after 36 weeks, 81% of CBT group, 81% of antidepressant groups and 86% of CBT + antidepressant group were significantly improved. This means there is a good case for making CBT the first choice of treatment in public health care systems such as the NHS.
• one limitation is the suitability for diverse clients.

  in severe cases depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT. they may not even be able to pay attention in a session. Sturmey (2005) suggests that any form of psychotherapy (including CBT) is not suitable for people with learning disabilities. this means that CBT may only be appropriate for a specific range of clients
• one limitation is the suitability for diverse clients: counterpoint

  there is now evidence to challenge this conventional wisdom. Lewis and lewis (2016) concluded that CBT was as effective as other treatments for severe depression. Taylor (2008) concluded that CBT can be effective for people with learning disabilities. this means that CBT may have a much wider application than was once thought
• one limitation of CBT is its high relapse rates

  few early studies looked at long term effectiveness and recent studies suggest that relapse is common. Ali (2017) assessed depression for 12 months following a course of CBT. 42% relapsed within 6 months of ended treatment and 53% within a year. this means that CBT may need to be repeated periodically.