8. The Cognitive Approach to Treating Depression

• 1. The Cognitive Approach to Treating Depression

  CBT:

  • Manage issues positively.
  • Thoughts/feelings/actions interconnected; negative thoughts trap patient in vicious cycle.
  • Breaks down problems into smaller parts; challenge patterns.
  • Deals w/ current problems.
• 1a. The Cognitive Approach to Treating Depression

  • Cognitive Element - irrational thoughts.
  • Behavioural Element - changing irrational thoughts.
• 1b. The Cognitive Approach to Treating Depression

  Process of CBT (Beck 1967):

  • Identify thoughts, negative triad.
  • Challenge.
  • Test reality of negative beliefs.
  • Patient = ‘scientist’.
  • Reproduction of evidence.
  • Behavioural Activation (decreases avoidance, increase engagement in activities to improve mood).
• 2. The Cognitive Approach to Treating Depression

  Rational Emotive Behavioural Therapy (REBT):

  • Thinking about events leads to emotional/behavioural upset.
  • Taught examine + challenge unhelpful thinking, which causes self-defeating behaviours.
  • Coping/achieving goals.
  • Focuses on present, addresses attitudes/emotions + maladaptive behaviours.
• 2a. The Cognitive Approach to Treating Depression

  Process of REBT (Ellis):

  • ABC, plus Dispute + Effect.
  • Identifying irrational thoughts.
  • Challenge thoughts.
  • Challenge utopianism.
  • Vigorous dispute.
  • Break link between negative events + depression.
• 2b. The Cognitive Approach to Treating Depression

  Challenging Beliefs:

  • Empirical Disputing - self-defeating beliefs not consistent w/ reality.
  • Logical Disputing - self-defeating belies not follow logically from info available (not make sense).
• The Cognitive Approach to Treating Depression (Evaluation)

  Strength - CBT:

  P - evidence support.

  E - March et al. (2007) compared CBT to antidepressants + combination of both when treating depressed.

  E - 81% CBT group, 81% antidepressants group + 86% of combination group improved; CBT just as effective used on own, more so when in combination.

  L - brief + cost-effective, first choice of treatment in NHS.
• The Cognitive Approach to Treating Depression (Evaluation)

  Limitation - CBT:

  P - lack of effectiveness for severe cases/learning disabilities.

  E - severe cases depression, can’t motivate self to engage in CBT.

  E - learning disabilities, psychotherapy unsuitable for them.

  L - lack generalisability, only suitable specific range people.
• The Cognitive Approach to Treating Depression (Evaluation)

  Strength - CBT:

  P - Lewis + Lewis (2016), CBT effective as antidepressants + behavioural therapies for severe depression.

  E - Taylor et al. (2008), effective for learning disabilities.

  L - suitable for wider range, generalisability.
• The Cognitive Approach to Treating Depression (Evaluation)

  Limitation - CBT:

  P - high relapse rates.

  E - lack of studies for long-term effect.

  E - Ali et al. (2017), assessed depression in clients; 42% relapsed within 6 months + 53% in year.

  L - may need repeating.