depression

• What are cognitive therapies for depression referred to as ?

  - CBT (cognitive behavioural therapy)
• Why?


  - It aims to challenge abnormal behaviours of depressives as well as change problematic thinking patterns
• How do all CBT sessions begin?

  - With the patient and the therapist discussing and clarifying the patient's problems.

  - Together they set goals and plan on how this could be achieved

  - The role of the therapist is to challenge irrational, negative thoughts of the patient

  - When the patient can think positively and rationally, their behaviour can then be changed too
• Outline the process of Beck's CBT [1]


  1) The patient and the therapist work together to identify negative elements of the triad;

  - Negative automatic thoughts the patient has about themselves, the world around them and their future

  2) These negative thoughts are directly challenged: a key part of CBT

  3) Homework tasks are set to challenge the negative thoughts (e.g. the patient may be asked to initiate conversation with a friend)

  - The patient is asked to keep a record of the event

  - This 'reality testing' can then be used by the therapist in future sessions
• Outline the process of Beck's CBT [2]

  4) This is referred to as patient as scientists as the patient is testing their own thoughts to see if their is any truth behind them

  - For example, the patient may say no-one like them but then they meet an old friend and have a really nice catch-up together

  5) The therapist can then use this to challenge the reality of negative automatic thoughts such 'no one likes me'

  6) In addition, problem solving and relaxation skills may be taught to the patient to help them deal with stressful situations

  7) Through reality testing, the patient can change their thoughts about themselves, the world and the future

  - This may lead to more +ve thoughts, which would reduce their depression
• Why did Ellis believe individuals developed self-defeating habits?

  - Due to irrational thoughts about activating events

  - Ellis developed his ABC model with D for dispute and E for effect
• What does REBT aim to do?

  - Help the client to understand the irrationality and the consequences of thinking this way

  - This allow the depressive to break the link between negative life events and the depressed state

  - REBT then helps the patient to develop effective problem-solving skills
• Outline the process for Ellis's REBT


  - The patient is encouraged to dispute any irrational beliefs and there are several methods for this:

  1) Logical disputing: self-defeating beliefs do not follow logically from the information e.g. does thinking this way make sense and reflect the facts

  2) Empirical disputing: self-defeating beliefs may not be consistent with reality e.g. where is the proofs these beliefs are real ?

  3) Pragmatic disputing: emphasises the lack of usefulness of self-defeating beliefs e.g. how is this belief likely to help me?

  - Effective disputing changes self-defeating beliefs into more rational beliefs

  - This helps people feel better by becoming more self-accepting, alleviating the depression
• Strength for cognitive therapies [1]


  - Supporting research for the effectiveness of CBT comes form March et al [2007]

  - They compared CBT to antidepressant drugs to a combination of both

  - After 36 weeks, there was an improvement of 81% of the CBT group, 81% of the drugs group and 86% for a combination of both

  - This clearly demonstrates that CBT is just as useful as drugs and therefore has high effectiveness

  - In addition, patents do not have the risk of becoming addicted to CBT as they have with drugs for example

  - This is a key strength of CBT in treating depression
• Weakness of cognitive therapies [1]

  - One key limitation of CBT is that it requires motivation to attend weekly sessions and engage with the therapist

  - Many people with depression suffer with low energy levels and so lack the motivation which makes it difficult for them to access the therapy in the first place

  - Even if they do turn up to the therapy, the tasks set such as 'patient as scientist' and keeping a diary requires effort which most depressives won't have

  - Drug therapies alternatively require less work and may work more effectively for some people

  - Therefore, this is a key limitation of CBT in treating depression
• Weakness of cognitive therapies [2]

  - Furthermore, research from Rosenweig [1936] argued the difference between methods of treating psychopathy (systematic desensitisation, CBT) is actually quite small

  - All psychotherapies share one key characteristic: the patient-therapist relationship

  - It could be the quality of this relationship which determines the success of the treatment, rather than any techniques used

  - If patients have a good therapist relationship, they are more likely to be willing to open up and fully access the therapy

  - Therefore, this again limits the utility of CBT in treating depression
• REBT


  - action-orientated psychotherapy that teaches individuals to identify, challenge and replace their irrational thoughts and beliefs with healthier thoughts that promote emotional well-being and goal achievement
• DEEL


  D argument: dispute irrational beliefs

  E: effect (feeling better) irrational negative beliefs to rational positive beliefs

  E argument: empirical argument - disputing whether there is evidence to support the irrational belief

  L argument: logical argument - disputing whether the negative thought actually follows from the facts
• criticism of DEEL


  many people with depression suffer from lowered self-esteem. arguing and telling them the way they think is incorrect will likely lower their self-esteem even further
• CBT


  - clients identify their own unhelpful beliefs and then proves them wrong. as a result, their beliefs begin to change.

  - e.g., someone who is anxious in social situations may be set a homework assignment to meet a friend at the pub for a drink

  - aim: 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

  - the 'client as a scientist': clients are encouraging to challenge the reality of their irrational beliefs. they may be set homework, e.g., journal when they enjoyed an event. this is referred to the 'client as a scientist'

  - in future sessions if client says that no one is nice to them, the therapist can produce this evidence to prove the client's belief are incorrect
• criticism of CBT


  some people with depression who suffer with lethargy may lack the energy to attend/pay attention in sessions
• research support


  - ellis found that on average patients took 27 sessions of therapy

  - from these patients they had a 90% success rate (reduction or elimination of symptoms)

  - therefore, REBT is suggested to be effective in its usage, and beneficial to those with mental illness
• suitability for diverse clients

  - in sever cases depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT or to pay attention in sessions

  - sturmey 2005 suggests that any form of psychotherapy is not suitable for people with learning difficulties

  - this means that CBT may only be appropriate for a specific range of clients
• COUNTERARGUMENT to prev AO3

  - Lewis and Lewis 2016 concluded that CBT was as effective as other treatments for severe depression

  - Taylor et al 2008 concluded that CBT can be effective for people with learning disabilities

  - this means that CBT may have much wider application that was once thought
• high relapse rates


  - few early studies looked at long-term effectiveness and recent studies suggest that relapse is common

  - Ali et al 2017 assessed depression for 12 months following a course of CBT. 42% relapsed within 6 months of ending treatment and 53% within a year

  - this means CBT may need to be repeated periodically
• client preference

  - a large body of evidence suggests that, uses appropriately, CBT is highly effective, at least in the short term, in tackling symptoms of depression

  - however, some clients prefer to take medications or explore the past, some rate CBT as least preferred therapy

  - this suggests that people, even those who are depressed, should have the right to chose their therapy even if it may not be the one with the best evidence of effectiveness
• less suitable for people with irrational beliefs

  - CBT appears to be less suitable for people with high levels of irrational beliefs that are rigid and resistant to change

  - they may find the situation too stressful and not be able to resolve their issues in therapy