depression

• Albert Ellis in the 1950s was one of the first psychologists to develop CBT. The aim of the therapy is to change irrational thoughts to rational ones. Ellis named his therapy as ‘rational emotive behavioural therapy’ (REBT). Ellis extended his ABC model to ABCDEF where D refers to disputing irrational thoughts, E refers to effects of disputing and effective attitude to life and F for new feelings and emotions that are produced. REBT focuses on the challenging the irrational thoughts which changes the consequence to a more positive one.
• REBT continued.. For example, logical disputing eg does thinking this way make sense? Empirical disputing, for example, where is the proof that this belief is accurate and lastly pragmatic disputing which is, for example how is this belief likely to help me? This helps the client move from ‘no one will ever like me’ to more rational interpretations such as ‘my friend was probably busy and didn’t even see me’. This helps the client feel better and hopefully become more self-accepting.
• rebt 3... Clients are also asked to put new beliefs into practice. For example, asking someone out on a date when they were scared to due to fear or rejection. CBT also often involves encouraging clients to become more active and engage in pleasurable activities. A characteristic of depression is that they loose love for activities they previously enjoyed.
• rebt 4... Ellis came to recognise that an important part of successful therapy was convincing the client of their value of a human being. If they feel worthless, they’ll be less willing to change. Unconditional positive regard must be given by the therapist to the client to help a change in beliefs and attitudes.  
• Depression: CBT does seem to work better for some individuals than others. For example, it seems to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change. Ellis also explained a possible lack of success in terms of sustainability, some people don’t want the direct advice that CBT practitioners tend to dispense as they prefer to talk to a therapist to share worries without getting involved in cognitive effort associated with recovery.

  A limitation therefore is the fact that individual differences does affect its effectiveness.
• depression: There is also the fact that other treatments are available such as antidepressants like SSRIs.

  Drug therapies require a lot less effort from the client due to the required 27 sessions of REBT which is a lot of commitment. They can be used in conjunction with CBT however which may be useful as it may make the client able to focus on the demands of CBT and drug treatment allows them to cope better. A review found that CBT was especially effective when used with drug therapies.

  This suggests that using both CBT and drug therapies may be the best option.
• There is support for behavioural activation helping individuals with depression.

  156 adult volunteers diagnosed with depression were studied. They were randomly assigned to a 4 month course of aerobic exercise, drug treatment or a combination of the two. Clients in all 3 groups exhibited significant improvements at the end. 6 months after the study, those in the exercise group had significantly lower relapse rates than those in the medication group.

  This shows that a change in behaviour can be beneficial in treating depression, lasting in the long term.
• Ellis claims a 90% success rate in the average of 27 sessions to complete the treatment. REBT and CBT in general have done well in outcome studies of depression. A review in 2013 of 75 studies found that CBT was superior to no treatment. Ellis recognised that sometimes it was not effective and suggested that the reason for this was the clients not putting beliefs into action. Therapist competence also can affect the level of success of treatment.

  This suggests that it is effective, however there can be influences from other factors such as from the client or therapist that can minimise this.
• Albert Ellis proposed that the key to mental disorders such as depression lay in irrational beliefs. His ABC model explains this. A refers to the activating event eg being fired at work. B is the belief which is either rational or irrational (‘they are just too overstaffed’ or ‘they all hate me and wanted me gone’. C is the consequence of this thoughts. Rational leads to healthy emotions, irrational leads to unhealthy, like depression.
• The source of irrational beliefs lies in musturbatory thinking. This is where certain beliefs have to be true for the individual to be happy. For example, ‘I must do well or I am worthless’ or ‘the world must give me happiness or I will die’. An individual with beliefs like this is likely to be at least disappointed or even depressed. For example, an individual who fails a test will become depressed due to the beliefs regarding the failure. ‘I must always do well so failing means I’m stupid.’ The ‘musts’ need to be changed in order for mental healthiness to prevail.
• Beck also developed a cognitive explanation that focused on depression. He says that depressed people have negative schema that has been acquired during childhood. This can be from a number of this such as peer rejection. These negatives schemas come into play whenever the individual approaches a new situation. Negative schemas are maintained by what Beck calls the negative triad. This is negative views of the self, the world and the future. For example, ‘everyone thinks im boring’- self, ‘even my bf left me’-world, ‘ill always be alone’- future.

   
• Irrational thinking being linked to depression has been supported by research.

  Bates 1999 found that depressed participants who were given negative automatic-thought statements became more and more depressed.

  This research supports the view that negative thinking leads to depression, although this link doesn’t mean that the thoughts cause depression. Instead it may develop due to depression.

   
• The cognitive approach suggests that it is the client who is responsible for their disorder.

  Placing emphasis on the client is a strength as it puts them in responsibility to think deeply about their feelings, and change their beliefs. This gives the client the power to change how they are. However, it does then ignore other factors (such as family issues) that may be highly influential to the clients depression.

  Therefore, the cognitive allows the participant to be in control of their own change, but it does focus maybe a little too much on the client and ignores other factors involved.
• A strength of the cognitive approach is the application to therapy.

  The cognitive explanation has been applied to the development of CBT for depression, which has been proved to be effective at the treatment of depression, as well as other disorders. This is especially true when used with drug treatments, so the patient can work harder on changing their irrational thoughts.

  The usefulness of CBT as a therapy supports the effectiveness of the cognitive approach and helps many people tackle their disorder.
• A limitation of the cognitive approach is that some irrational beliefs may just seem irrational.

  This has been said to be the ‘sadder but wiser effect’ as the beliefs are sometimes realistic and they just see things as they really are. Depressed people give a more likelihood of what is actually the outcome of disasters than normal controls.

  This then causes doubts about whether these ‘irrational’ thoughts are actually irrational. This would then cause doubt on the value of the theory.