Cognitive approach to treating depression

• what is the main way depression is treated?

  cognitive behaviour therapy (CBT)
• Beck: patient and therapist work together

  they work together to clarify the patient's problems and identify where there might be negative or irrational thought that will benefit from challenge.
• challenging negative thoughts relating to negative triad

  aim is to identify negative thoughts about the self, the world and the future- the negative triad. these thoughts must be challenged by the patient taking an active role in their treatment.
• 'patient as scientist'

  patients encourages to test the reality of their beliefs. may be set homework, e.g. to record when people were nice to them (referred to as 'patient as scientist'. in future sessions if patients say that no-one is nice to them, the therapist can produce this evidence to prove the patient's beliefs incorrect.
• ellis' rational emotive behaviour therapy (REBT)

  extends the ABC model to an ABCDE model:

  D for dispute irrational beliefs.

  E for effect.
• challenging irrational beliefs

  a patient may talk about how unlucky they have been or how unfair life is. an REBT therapist would identify this as utopianism and challenge it as an irrational belief:

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

  as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms. the goal of treatment, 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 for dinner etc.
• strength of CBT: it is effective

  lots of evidence to support. march et al. compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. after 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of the CBT+antidepressant group were significantly improved. proved CBT just as effective as medication and helpful alongside medication. suggests there's a good case for making CBT the first choice of treatment in public health care systems like the NHS.
• limitation of CBT: some patients really want to explore their past

  one of the basic principles of CBT is that the focus of the therapy is on the patient's present and future, not the past. in other form of psychotherapy patients make links between childhood experiences and current depression. the 'present-focus' of CBT may ignore an important aspect of the depressed patient's experience.
• limitation of CBT: overemphasis on cognition

  CBT may minimise the importance of the circumstances in which the patient is living. a patient living in poverty or suffering abuse needs to change their circumstances, and any approach that emphasises what is in the patient's mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation.
• limitation: may not work for the most severe cases of depression

  in some cases depression can be so severe that patients cannot motivate themselves to take on the hard cognitive work required for CBT. where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression