CBT

• Cognitive behavioural therapy (CBT)

  CBT is based on the cognitive approach including challenging irrational thoughts for treating depression
• Depression


  A result of distorted thought processes
• CBT strategies


  1. Identifying irrational thoughts

  2. Challenging irrational thoughts

  3. Behavioural activation

  4. Homework
• Identifying irrational thoughts


  The therapist works with the patient to help them identify irrational thinking and maladaptive thoughts. The client is encouraged to record their automatic negative thoughts and evidence of behaviour/incidents. They are then asked to compare the evidence with the thoughts to see whether their thoughts are a rational response.
• Challenging irrational thoughts


  • Logical disputing whether the negative thought logically follows from the facts
  • looking for evidence as to whether the belief is accurate
  • emphasises the lack of usefulness of these beliefs
• Behavioural activation


  Part of the therapy aims to alter dysfunctional behaviours that are contributing to or maintaining the depression. This is done by encouraging patients to identify activities they used to enjoy and to work to overcome cognitive obstacles in carrying them out. They are also asked to record their participation and their mood afterwards. These behaviours should increase mood and help to change negative thinking.
• Homework


  Homework is also given to allow the client to try out new ways of thinking. In severe depression the person may find it difficult to do anything at all. CBT would encourage them to set a list of small goals to be achieved. These could be as trivial as actually getting out of bed and making a cup of tea. These small achievements should help the depressed person develop a sense of personal effectiveness. As CBT continues, the individual will engage in progressively more rewarding activities.
• Effectiveness of CBT


  • Research evidence shows CBT is as effective as antidepressants, but with the added benefit of reducing suicide attempts more than drugs
  • CBT aims to tackle more than just the symptoms of depression, it also aims to promote resilience and improve social functioning, so it is more likely to improve a patient's quality of life beyond just treating the symptoms
• Limitations of CBT effectiveness

  • The quality of the therapist-patient relationship may be more important than the features of the treatment
  • CBT is not effective for everyone, especially those with high levels of realistic stress
  • CBT requires commitment from the individual, which can be difficult for someone who is depressed and lacks motivation
• Combined CBT with SSRIs are more likely to be effective
• Effectiveness of CBT as a treatment for depression

  Decreases over time
• There is research evidence to support the effectiveness of CBT
• Research evidence


  • March et al. (2007) found 81% of adolescents who received CBT to treat depression demonstrated improvements in mood after 36 weeks, the same percentage as using antidepressants
  • TADS Team (2007) found antidepressants and CBT had equal success rates in treating depression after 36 weeks, but suicidal events were more common in patients receiving antidepressants (14.7%) than combination therapy (8.4%) or CBT (6.3%)
• CBT


  • Aims to tackle more than just the symptoms of depression
  • Aims to promote resilience and improve social functioning such as social isolation and unemployment in depressive patients
  • More likely to improve a patient's quality of life beyond just treating the symptoms of the depression
  • Less likely to lead to a relapse
• Quality of therapist-patient relationship


  More important than the features of the treatment given
• Research shows minimal differences between the effectiveness of different therapies
• CBT is not effective for everyone, especially those with high levels of stress that reflect realistic stressors in the person's life
• CBT requires commitment from the individual, which can be difficult for someone who is depressed and lacks motivation
• Combined CBT with SSRIs are more likely to be effective
• CBT


  • Teaches clients skills to challenge irrational thoughts
  • Can help prevent a relapse of depressive thoughts
• CBT


  • Can be delivered in a variety of ways (e.g. computerised packages, smartphone apps, over the phone, online video chat)
  • Flexible delivery makes it more suitable for a wider range of people
• CBT


  • Non-invasive, no side effects
• Changing thought patterns through CBT may be difficult, especially for those with severe depression who lack motivation
• CBT is expensive, requiring trained therapists, which may limit its availability compared to cheaper antidepressants