cognitive treatments

• CBT involves both cognitive and behavioural elements. 

  The cognitive element - 

  • This identifies irrational and negative thoughts that lead to depression.
  • The aim is then to replace these with more positive thoughts 

  The behavioural element - 

  • This encourages patients to test their beliefs through behavioural experiments and homework
• There are various components to CBT: 

  • Initial assessment 
  • Goal setting 
  • Identifying negative / irrational thoughts and challenging them [either using becks cognitive therapy or Ellis’s REBT] 
  • Homework
• Beck’s cognitive therapy 

  • If a therapist is using Beck’s cognitive therapy, they will help the patient identify their negative thoughts in relation to themselves, their world and their future. This is using the negative triad 
  • The patient and therapist then work together to challenge the irrational thoughts, they do this by discussing the evidence in support of, and against the irrational thoughts. 
  • The patient is encouraged through this process to test how valid the thoughts are, and they may be assigned homework to challenge their negative thoughts and put them to test. 
• • Ellis adapted his ABC to include D [dispute] and E [affect or effective] 
  • main idea is to challenge irrational thoughts, achieved through dispute
  • The therapist will dispute the patient’s irrational beliefs to replace them with effective beliefs and attitudes 
  • Different types of dispute can be used: logical dispute [questions the logic of the thinking] or empirical dispute [therapist seeks evidence for the individuals irrational thoughts] 
  • After a session, the therapist may set homework. patient can identify their own irrational beliefs and then prove them wrong independently.
• • Cognitive behavioural therapy comes from research evidence which demonstrated its effectiveness in treating depression
• • March et al- found that CBT was as effective as antidepressants in treating depression. They examined 327 adolescents with depression and looked at the effectiveness of CBT, antidepressants, and a combination of CBT and antidepressants. After 36 weeks, it was found that 81% of the antidepressant group and 81% of the CBT group had significantly improved, this showed CBTS effectiveness. However, 85% of the CBT + antidepressant group had significantly improved, suggesting that a combination of the two treatments may be most effective
• An issue with CBT is that it requires motivation from the patient. Those with severe depression may not engage with CBT or even attend the sessions. This makes it ineffective. Alternate treatments, such as antidepressants do not require this kind of motivation and may be more effective in these cases.
• CBT has been criticised for overemphasising the role of cognition. Some psychologists have criticised it because it suggests that a person’s irrational thinking is the primary cause of depression and CBT does not take into account the other factors. For example, it could be that the patient's circumstance is causing their depression, therefore CBT would be ineffective until their circumstance had changed. [e.g. domestic abuse]
• • Antidepressants are the first treatment that comes to mind, however they only treat the symptoms and not the cause
  • In order to treat it you need to find the root cause which could be to do with how people view themselves and the world. 
  • CBT aims to change the way clients think by challenging their thought processes, leading to a change in behaviour
  • CBT is expensive and time consuming, and it is down to how motivated the patient is and how willing they are to change. It also relies on a good relationship with the therapist and the client.
• Ellis’ ABC model

  A - Activating event 

  B - beliefs about event

  C - consequences

  D - disputing irrational thoughts and beliefs

  E - effects of the new beliefs and attitudes

  F - feelings
• therapies will set their clients homework tasks, e.g. putting themselves into uncomfortable situations or telling their friends and family how they feel

  Another key part is behavioural activation, where clients are encouraged to be more active and take part in more enjoyable activities. E.g. physical activity lifts moods and many people who suffer with depression no longer take part in physical activities

  Ellis also believed in the humanist ideal of unconditional positive regard. This involves convincing the client of their own self worth and encouraging them to love themselves.
• t has also been criticised for focusing too much on cognitions, some psychologists have criticised it by saying that it says that the primary cause for someone's depression is their irrational thinking.  CBT also does not take into account other factors e.g. grief. This means that CBT would also be ineffective until someone’s situation has changed.
• Elkin et al - 

  • This was a study that ran across several treatment centres. 
  • 240 patients were treated with CBT, psychotherapy or antidepressant drugs 
  • there was also a placebo control group
  • Treatment lasted for 16 weeks 
  • They found that there was a large placebo effect of 35-40%. However, all therapies were significantly more effective than the placebo and overall had similar levels of effectiveness 
  • Drugs tended to be the most effective for severe depression
  • The individual therapist was a significant factor in effectiveness
  • all groups, 30-40% of patients did not respond to therapy.
• elkin et al-

  The conclusions were that drugs, CBT, and psychotherapy are all more effective than a placebo in treating depression. However, the check up after treatment was only 16 weeks, ideally patients should be followed up for 6 - 12 months, as there is evidence that the effect of CBT in anxiety conditions is longer lasting than the effect of drugs